Displaced pilon fx unsp tibia, subs for clos fx w malunion

This code signifies a pilon fracture, which is a break at the weight-bearing surface of the distal tibia, that has healed improperly (malunion) and is still displaced. The injury location is unspecified as to left or right tibia. This code is used during the healing phase after initial treatment, when the fracture has not aligned correctly.

This code is appropriate for follow-up encounters where a patient is being managed for a previously treated pilon fracture of the tibia that has resulted in malunion. It applies when the fracture was initially closed and the displacement persists despite healing. This would be used for ongoing care, such as monitoring, planning for corrective surgery, or managing complications related to the malunion.

• Always confirm the fracture is a pilon type and that malunion is documented.
• Verify that the encounter is for a "subsequent encounter" and the fracture was initially "closed."
• If laterality (left or right) is specified in the documentation, a more specific code should be used.