S49.129A — Salter-Harris Type II physeal fracture of lower end of humerus, unspecified arm, initial encounter for closed fracture
Is S49.129A billable?
Yes, but S49.129A will trip a Medicare edit. S49.129A is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists S49.129A 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.
S49.129A at a glance
| Code | S49.129A |
|---|---|
| Description | Salter-Harris Type II physeal fracture of lower end of humerus, unspecified arm, initial encounter for closed fracture |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "A" | initial encounter for closed fracture |
What does the 7th character "A" mean in S49.129A?
In S49.129A, the 7th character A means initial encounter for closed fracture. The 7th character is required for S49.129A to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
- Ainitial encounter for closed fractureS49.129A
- Dsubsequent encounter for fracture with routine healingS49.129D
- Gsubsequent encounter for fracture with delayed healingS49.129G
- Ksubsequent encounter for fracture with nonunionS49.129K
- Psubsequent encounter for fracture with malunionS49.129P
- SsequelaS49.129S
What Medicare edits apply to S49.129A?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name S49.129A 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 S49.129A group to?
S49.129A sits in MDC 08 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 562Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh with MCCmedical
- 563Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh without MCCmedical
As a secondary diagnosis, S49.129A is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG. It also carries Hospital-Acquired Condition category 05.
How is S49.129A listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S49.12, the nearest indexed parent of S49.129A. Use them to find the family, then select the specific code.
- Fracture, traumatic › humerus › lower end › physeal › Salter-Harris › Type II (abduction) (adduction) (separation)
Use additional code — inherited from Chapter 19
Report an additional code alongside S49.129A to fully describe the condition. S49.129A 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 S49.129A, but a patient may have both at the same time. When documentation supports it, S49.129A and the excluded code may both be reported.
Excludes2 — not included here — inherited from S40-S49
The conditions below are not part of S49.129A, but a patient may have both at the same time. When documentation supports it, S49.129A and the excluded code may both be reported.
How long has S49.129A existed?
S49.129A 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.