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

This code signifies a Salter-Harris Type II fracture affecting the growth plate at the proximal end of the right tibia, specifically when the fracture has healed in an anatomically incorrect position (malunion). This type of fracture involves both the physis and a portion of the metaphysis.

Apply this code when a patient presents for follow-up care, evaluation, or treatment of a previously diagnosed Salter-Harris Type II physeal fracture of the upper right tibia that has resulted in malunion. This includes situations where the malunion is being monitored, or surgical intervention for correction is being planned or performed.

• Ensure documentation clearly states "malunion" and specifies the "subsequent encounter" for this condition.
• Verify the fracture is indeed a Salter-Harris Type II and located at the upper end of the right tibia.
• Do not use this code for initial treatment or for nonunion; specific codes exist for those scenarios.