S49.019P — Salter-Harris Type I physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with malunion
Is S49.019P billable?
Yes, but S49.019P will trip a Medicare edit. S49.019P is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists S49.019P 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.
S49.019P at a glance
| Code | S49.019P |
|---|---|
| Description | Salter-Harris Type I physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with malunion |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "P" | subsequent encounter for fracture with malunion |
What does the 7th character "P" mean in S49.019P?
In S49.019P, the 7th character P means subsequent encounter for fracture with malunion. The 7th character is required for S49.019P to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
- Ainitial encounter for closed fractureS49.019A
- Dsubsequent encounter for fracture with routine healingS49.019D
- Gsubsequent encounter for fracture with delayed healingS49.019G
- Ksubsequent encounter for fracture with nonunionS49.019K
- Psubsequent encounter for fracture with malunionS49.019P
- SsequelaS49.019S
What Medicare edits apply to S49.019P?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name S49.019P 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 S49.019P group to?
S49.019P sits in MDC 08 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.
- 564Other Musculoskeletal System and Connective Tissue Diagnoses with MCCmedical
- 565Other Musculoskeletal System and Connective Tissue Diagnoses with CCmedical
- 566Other Musculoskeletal System and Connective Tissue Diagnoses without CC/MCCmedical
As a secondary diagnosis, S49.019P is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is S49.019P listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S49.01, the nearest indexed parent of S49.019P. Use them to find the family, then select the specific code.
- Fracture, traumatic › humerus › upper end › physeal › Salter-Harris › Type I (abduction) (adduction) (separation)
Use additional code — inherited from Chapter 19
Report an additional code alongside S49.019P to fully describe the condition. S49.019P 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 S49.019P, but a patient may have both at the same time. When documentation supports it, S49.019P and the excluded code may both be reported.
Excludes2 — not included here — inherited from S40-S49
The conditions below are not part of S49.019P, but a patient may have both at the same time. When documentation supports it, S49.019P and the excluded code may both be reported.
How long has S49.019P existed?
S49.019P 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.