Zygomatic fracture, unspecified side, sequela

This code describes a long-term complication or late effect resulting from a previous fracture of the zygomatic bone (cheekbone), where the specific side of the face affected is not documented. It indicates that the initial injury has healed, but the patient is now experiencing residual problems directly attributable to that past fracture.

Use this code when documentation clearly states a sequela (e.g., malunion, nonunion, chronic pain, deformity, functional impairment) of a prior zygomatic fracture, and the medical record does not specify whether the fracture was on the left or right side. This code is appropriate for encounters addressing these persistent issues, not the initial acute injury.

• Always sequence the sequela code first, followed by codes for the specific manifestation(s) of the sequela (e.g., M84.08 for malunion).
• Ensure documentation explicitly links the current condition to a previous zygomatic fracture.
• Avoid using this code for acute or active fractures; those require codes from the S02.4- series without the "S" seventh character.