S59.249A — Salter-Harris Type IV physeal fracture of lower end of radius, unspecified arm, initial encounter for closed fracture
Is S59.249A billable?
Yes, but S59.249A will trip a Medicare edit. S59.249A is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists S59.249A 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.
S59.249A at a glance
| Code | S59.249A |
|---|---|
| Description | Salter-Harris Type IV physeal fracture of lower end of radius, 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 S59.249A?
In S59.249A, the 7th character A means initial encounter for closed fracture. The 7th character is required for S59.249A to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
- Ainitial encounter for closed fractureS59.249A
- Dsubsequent encounter for fracture with routine healingS59.249D
- Gsubsequent encounter for fracture with delayed healingS59.249G
- Ksubsequent encounter for fracture with nonunionS59.249K
- Psubsequent encounter for fracture with malunionS59.249P
- SsequelaS59.249S
What Medicare edits apply to S59.249A?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name S59.249A 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 S59.249A group to?
S59.249A 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, S59.249A 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 S59.249A listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S59.24, the nearest indexed parent of S59.249A. Use them to find the family, then select the specific code.
- Fracture, traumatic › radius › lower end › physeal › Salter-Harris › Type IV (abduction) (adduction) (separation)
Use additional code — inherited from Chapter 19
Report an additional code alongside S59.249A to fully describe the condition. S59.249A 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 S59.249A, but a patient may have both at the same time. When documentation supports it, S59.249A and the excluded code may both be reported.
Excludes2 — not included here — inherited from S50-S59
The conditions below are not part of S59.249A, but a patient may have both at the same time. When documentation supports it, S59.249A and the excluded code may both be reported.
Excludes2 — not included here — inherited from S59
The conditions below are not part of S59.249A, but a patient may have both at the same time. When documentation supports it, S59.249A and the excluded code may both be reported.
- other and unspecified injuries of wrist and hand (S69.-)
How long has S59.249A existed?
S59.249A 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.