S92.416P — Nondisplaced fracture of proximal phalanx of unspecified great toe, subsequent encounter for fracture with malunion
Is S92.416P billable?
Yes, but S92.416P will trip a Medicare edit. S92.416P is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists S92.416P 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.
More specific alternatives
- S92.411PDisplaced fracture of proximal phalanx of right great toe, subsequent encounter for fracture with malunion
- S92.412PDisplaced fracture of proximal phalanx of left great toe, subsequent encounter for fracture with malunion
- S92.414PNondisplaced fracture of proximal phalanx of right great toe, subsequent encounter for fracture with malunion
- S92.415PNondisplaced fracture of proximal phalanx of left great toe, subsequent encounter for fracture with malunion
S92.416P at a glance
| Code | S92.416P |
|---|---|
| Description | Nondisplaced fracture of proximal phalanx of unspecified great toe, 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 S92.416P?
In S92.416P, the 7th character P means subsequent encounter for fracture with malunion. The 7th character is required for S92.416P to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
- Ainitial encounter for closed fractureS92.416A
- Binitial encounter for open fractureS92.416B
- Dsubsequent encounter for fracture with routine healingS92.416D
- Gsubsequent encounter for fracture with delayed healingS92.416G
- Ksubsequent encounter for fracture with nonunionS92.416K
- Psubsequent encounter for fracture with malunionS92.416P
- SsequelaS92.416S
What Medicare edits apply to S92.416P?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name S92.416P 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 S92.416P group to?
S92.416P 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, S92.416P is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is S92.416P listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S92.41, the nearest indexed parent of S92.416P. Use them to find the family, then select the specific code.
- Fracture, traumatic › toe › great › proximal phalanx (abduction) (adduction) (separation)
- Fracture, traumatic › toe › great › proximal phalanx › nondisplaced (abduction) (adduction) (separation)
Use additional code — inherited from Chapter 19
Report an additional code alongside S92.416P to fully describe the condition. S92.416P 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 S92.416P, but a patient may have both at the same time. When documentation supports it, S92.416P and the excluded code may both be reported.
Excludes2 — not included here — inherited from S90-S99
The conditions below are not part of S92.416P, but a patient may have both at the same time. When documentation supports it, S92.416P and the excluded code may both be reported.
Excludes2 — not included here — inherited from S92
The conditions below are not part of S92.416P, but a patient may have both at the same time. When documentation supports it, S92.416P and the excluded code may both be reported.
Excludes2 — not included here — inherited from S92.4
The conditions below are not part of S92.416P, but a patient may have both at the same time. When documentation supports it, S92.416P and the excluded code may both be reported.
- Physeal fracture of phalanx of toe (S99.2-)
How long has S92.416P existed?
S92.416P 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.