Stress fracture, right shoulder, subs for fx w delay heal

This code signifies a stress fracture affecting the right shoulder, indicating a break in the bone due to repetitive stress rather than a single traumatic event. The "subsequent encounter" aspect specifies that the patient is receiving follow-up care for this fracture, and the "delayed healing" component denotes that the bone is not mending at the expected rate.

Apply this code when a patient presents for ongoing treatment of a previously diagnosed stress fracture of the right shoulder that is exhibiting delayed union. Documentation should clearly state the location of the stress fracture, the "subsequent encounter" status, and explicitly mention delayed healing or non-progression of healing.

• Ensure documentation specifies "stress fracture" and not a traumatic fracture, as different codes apply.
• Verify the laterality (right shoulder) is clearly documented to avoid incorrect coding.
• Confirm the encounter type is "subsequent" and that delayed healing is explicitly noted by the provider.