Type III occipital condyle fracture, right side, sequela

This code signifies a chronic or late effect of a Type III occipital condyle fracture on the right side. A Type III fracture involves an avulsion of the alar ligament insertion, often associated with craniocervical instability. "Sequela" indicates that the acute injury has healed, but the patient continues to experience residual effects or complications directly attributable to the original fracture.

Apply this code when documentation clearly indicates a healed right-sided Type III occipital condyle fracture, and the patient is presenting for treatment of a long-term complication or residual symptom directly resulting from that past injury. Examples include chronic pain, instability requiring ongoing management, or neurological deficits that persist after the acute phase of the fracture. The medical record must explicitly state "sequela" or describe a chronic condition linked to the prior fracture.

• Ensure documentation specifies "sequela" or a chronic condition directly linked to the past fracture, not an acute injury.
• Verify the fracture type (Type III) and laterality (right side) are clearly documented.
• Do not use this code for the initial or acute treatment of a Type III occipital condyle fracture; use the appropriate acute fracture code.