Nondisp trimalleol fx unsp low leg, 7thH

This code describes a fracture involving all three malleoli (medial, lateral, and posterior) of an unspecified lower leg, which is not displaced. It specifically applies when the fracture was initially an open fracture of Gustilo type I or II, and the patient is now presenting for follow-up care due to delayed healing of that open fracture.

Use this code for subsequent encounters when a patient with a previously diagnosed nondisplaced trimalleolar fracture, initially classified as an open fracture type I or II, is experiencing slower-than-expected bone healing. This applies to follow-up visits, cast changes, or imaging to assess the progress of delayed union.

• Ensure documentation clearly specifies "nondisplaced" and "trimalleolar" for the fracture.
• Verify the original injury was an "open fracture type I or II" and that healing is explicitly noted as "delayed."
• This code requires an unspecified laterality for the lower leg; if laterality is known, a more specific code should be used.