Nondisp spiral fx shaft of unsp femr, 7thQ

This code describes a follow-up encounter for a spiral fracture in the shaft of an unspecified femur that was initially an open fracture (Type I or II) and has now healed incorrectly, resulting in malunion. The fracture itself is currently nondisplaced.

Use this code when documenting ongoing care for a patient with a previously treated open spiral femoral shaft fracture (Type I or II) that has healed in an anatomically incorrect position. This applies to subsequent visits where the malunion is being managed, but the fracture itself is no longer displaced.

• Ensure the documentation specifies an open fracture type I or II for the initial injury.
• Verify that the encounter is for follow-up care and not the initial treatment of the fracture.
• Confirm that the physician's notes explicitly state "malunion" as a complication of the healing process.