S22.49XB — Multiple fractures of ribs, unspecified side, initial encounter for open fracture
Is S22.49XB billable?
Yes, but S22.49XB will trip a Medicare edit. S22.49XB is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists S22.49XB under Medicare Code Editor edit 20, “Unspecified code” — meaning a code specifying laterality (right, left or bilateral) exists in the same family. On an inpatient claim this triggers the edit, because CMS holds that there are very limited circumstances in which laterality cannot be documented.
S22.49XB at a glance
| Code | S22.49XB |
|---|---|
| Description | Multiple fractures of ribs, unspecified side, initial encounter for open fracture |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "B" | initial encounter for open fracture |
What does the 7th character "B" mean in S22.49XB?
In S22.49XB, the 7th character B means initial encounter for open fracture. The 7th character is required for S22.49XB to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
What Medicare edits apply to S22.49XB?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name S22.49XB directly.
A code specifying laterality (right, left or bilateral) exists in the same family. CMS holds that there are very limited circumstances in which laterality cannot be documented.
Which MS-DRGs does S22.49XB group to?
S22.49XB sits in MDC 04 and helps define the logic of 3 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 183Major Chest Trauma with MCCmedical
- 184Major Chest Trauma with CCmedical
- 185Major Chest Trauma without CC/MCCmedical
As a secondary diagnosis, S22.49XB is a major complication or comorbidity (MCC), which can move a stay into a higher-paying DRG. It also carries Hospital-Acquired Condition category 05.
How is S22.49XB listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S22.4, the nearest indexed parent of S22.49XB. Use them to find the family, then select the specific code.
- Fracture, traumatic › rib › multiple (abduction) (adduction) (separation)
- Fracture, traumatic › thorax › rib › multiple (abduction) (adduction) (separation)
Excludes1 — never code together — inherited from S22
The conditions below can never be reported together with S22.49XB on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- transection of thorax (S28.1)
Excludes1 — never code together — inherited from S22.4
The conditions below can never be reported together with S22.49XB on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- flail chest (S22.5-)
Code first — inherited from S22
The underlying condition below must be sequenced before S22.49XB. S22.49XB describes a manifestation and cannot be the principal or first-listed diagnosis.
Use additional code — inherited from Chapter 19
Report an additional code alongside S22.49XB to fully describe the condition. S22.49XB is sequenced first.
- code to identify any retained foreign body, if applicable (Z18.-)
Excludes2 — not included here — inherited from Chapter 19
The conditions below are not part of S22.49XB, but a patient may have both at the same time. When documentation supports it, S22.49XB and the excluded code may both be reported.
Excludes2 — not included here — inherited from S20-S29
The conditions below are not part of S22.49XB, but a patient may have both at the same time. When documentation supports it, S22.49XB and the excluded code may both be reported.
- burns and corrosions (T20-T32)
- effects of foreign body in bronchus (T17.5)
- effects of foreign body in esophagus (T18.1)
- effects of foreign body in lung (T17.8)
- effects of foreign body in trachea (T17.4)
- frostbite (T33-T34)
- injuries of axilla
- injuries of clavicle
- injuries of scapular region
- injuries of shoulder
- insect bite or sting, venomous (T63.4)
Excludes2 — not included here — inherited from S22
The conditions below are not part of S22.49XB, but a patient may have both at the same time. When documentation supports it, S22.49XB and the excluded code may both be reported.
Code also — inherited from S22
Two codes may be needed to describe the condition fully. Whether S22.49XB is sequenced first depends on the reason for the encounter.
How long has S22.49XB existed?
S22.49XB has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.