Can the new work‑related wrist pain, with a healed prior fracture and no acute radiographic or laboratory abnormalities, be coded as an over‑use (repetitive‑strain) injury and is there an ICD‑10‑CM code to capture the previous fracture?

Coding Work-Related Wrist Pain with Prior Healed Fracture

Yes, this can be coded as an overuse/repetitive strain injury, and the prior fracture should be documented with a sequela code to capture the complete clinical picture.

Primary Diagnosis: Overuse Injury Coding

The current presentation meets criteria for a work-related repetitive strain injury and should be coded as such. 1, 2, 3

• Repetitive strain injuries are defined as disorders resulting from recurrent overuse causing microtrauma to tissues, presenting with local pain, tenderness, and limited function 1
• The temporal relationship between starting a job requiring "extra wrist motion and torque" and onset of new pain establishes this as an occupational repetitive strain injury 2, 4
• The diagnosis is clinical and does not require radiographic abnormalities—normal x-rays and labs do not exclude overuse injury 1, 5

Appropriate ICD-10-CM Codes:

• Primary code: Use a code from the M70 series (soft tissue disorders related to use, overuse and pressure), such as:

  • M70.03- (other soft tissue disorders related to use, overuse and pressure of wrist)
  • Specify laterality (right/left) with the 6th character 5

• External cause code: Add a Y93 code to document the work-related nature (e.g., Y93.D for activities involving computer technology and electronic devices, or other appropriate occupational activity code) 2, 4

Secondary Diagnosis: Prior Fracture Documentation

The healed malunion should be coded as a sequela to provide complete documentation of factors potentially contributing to current symptoms.

• Use a sequela code from the S62 series (fracture of wrist and hand level) with the 7th character "S" to indicate sequela of the previous fracture 5
• Document "personal history of healed fracture" using Z87.81 if the malunion itself is not currently symptomatic but contextually relevant 5

Clinical Rationale for Dual Coding:

• The improperly set fracture may have altered wrist biomechanics, predisposing to overuse injury with new occupational demands 3, 5
• Even though x-rays show "no chronic changes," the history of malunion is clinically significant for understanding vulnerability to repetitive strain 1, 5
• This dual coding approach captures both the acute work-related pathology and the relevant past medical history that may influence treatment planning and prognosis 2, 4

Key Documentation Elements

Document these specific clinical features to support your coding:

• Temporal relationship: Pain onset after starting new job with increased wrist demands 2, 4
• Occupational activities: Specific motions (repetitive flexion/extension, forceful gripping, awkward postures) 2, 3
• Physical examination: Localized tenderness, pain with specific motions, weakness, limited range of motion 1, 2
• Negative findings: No acute fracture, no arthritis, normal inflammatory markers (WBC, uric acid) ruling out infection and crystalline arthropathy 6, 5
• Prior injury: Document the healed fracture, that it was "not properly set," and that it healed without issue until new occupational demands 5

Common Coding Pitfalls to Avoid

• Do not code this as an acute traumatic injury—there is no single traumatic event, and the mechanism is cumulative microtrauma 1, 2
• Do not use only the sequela code—the current symptomatic presentation is new overuse pathology, not a complication of the old fracture 3, 4
• Do not omit the external cause code—work-relatedness has significant implications for workers' compensation and occupational health interventions 2, 4
• Do not code as "wrist pain, unspecified"—the clinical picture clearly establishes repetitive strain injury as the diagnosis 1, 5

Treatment and Workplace Modification Documentation

• Document conservative management: Rest, ice, NSAIDs, splinting as indicated 1, 2, 3
• Note ergonomic assessment recommendations and workplace modifications needed to prevent reinjury 2, 4
• If symptoms persist despite conservative treatment, consider advanced imaging (MRI without contrast) to evaluate for tendinopathy, ligamentous injury, or occult stress injury not visible on plain films 6, 5