3-part fx surgical neck of l humerus, subs for fx w malunion

This code signifies a fracture involving three distinct fragments at the surgical neck of the left humerus that has healed in an unsatisfactory position, resulting in a deformity. The patient is no longer in the initial healing phase but is receiving ongoing care for the improperly united fracture.

Apply this code when a patient presents for follow-up treatment, rehabilitation, or evaluation of a previously sustained 3-part surgical neck fracture of the left humerus, and imaging or clinical assessment confirms malunion. This is appropriate for encounters where the primary focus is managing the consequences of the malunited fracture, such as pain, limited range of motion, or planning for corrective surgery.

• Ensure documentation clearly specifies "malunion" and not "nonunion" or "delayed healing" for this specific code.
• Verify the fracture location is the "surgical neck" and not another part of the humerus.
• Confirm laterality (left humerus) and the 3-part nature of the fracture are explicitly documented.