Pathological fracture, left tibia, subs for fx w delay heal

This code signifies a fracture of the left tibia that occurred due to an underlying disease process, rather than trauma, and is currently in a phase of delayed healing. It indicates that the patient is receiving active treatment or follow-up care for this specific complication.

Apply this code when documentation clearly states a pathological fracture of the left tibia and explicitly mentions delayed healing. This is appropriate for subsequent encounters where the patient is still under care for the fracture and its healing complication. Supporting documentation would include physician notes detailing the pathological nature of the fracture and the ongoing issue of delayed union.

• Ensure documentation specifies "pathological fracture" and not just a general fracture.
• Verify the laterality (left tibia) and the encounter type (subsequent encounter for delayed healing).
• Always sequence the underlying condition causing the pathological fracture (e.g., osteoporosis, neoplasm) before this code.