Sltr-haris Type II physl fx upr end l tibia, 7thP

This code signifies a specific growth plate injury affecting the upper part of the left shin bone, where the fracture line extends through the growth plate and into the metaphysis. It indicates that the patient is in a later stage of treatment for this fracture, and the bone has healed in an unsatisfactory position, resulting in a deformity.

Apply this code when documenting follow-up care for a patient with a previously diagnosed Salter-Harris Type II fracture of the proximal left tibia, and imaging or clinical assessment confirms that the fracture has united with an unacceptable alignment. This would be used for ongoing management of the malunion, such as planning for corrective surgery or monitoring its impact.

• Ensure documentation clearly specifies "left tibia" and "upper end" to differentiate from other locations.
• Verify that the encounter is for a "subsequent encounter" and that "malunion" is explicitly stated or clearly implied by the clinical findings.
• Do not use this code for initial fracture treatment or for nonunion; specific codes exist for those scenarios.