S49.049A vs S49.049P

S49.049A (Salter-Harris Type IV physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture) compared with S49.049P (Salter-Harris Type IV physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with malunion), from the official CMS tabular data. S49.049A and S49.049P code the same injury at a different phase of treatment.

Relationship

Review

Encounter relationship

S49.049A

Initial encounter

Salter-Harris Type IV physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture

↔

S49.049P

Subsequent encounter

Salter-Harris Type IV physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with malunion

Same underlying diagnosis, different encounter phase.

The 7th character records the phase of care for the encounter being coded, so a single encounter takes one of these characters, not several. Review whether both phases belong on the same episode of care.

Source: ICD-10-CM Official Guidelines, Section I.C.19.a

Can these codes be reported together?

Same injury, other encounter phase. S49.049A and S49.049P code the same injury at a different phase of treatment, set by the 7th character.

The 7th character records the type of care given at the encounter being coded (ICD-10-CM Official Guidelines, Section I.C.19.a), so one encounter takes one of these, not both.

Side by side

	S49.049ASalter-Harris Type IV physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture	S49.049PSalter-Harris Type IV physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with malunion
Billing status	Billable	Billable
Classification	S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88)	S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88)
Definition	Salter-Harris Type IV physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture is a billable ICD-10-CM diagnosis code (S49.049A).	Salter-Harris Type IV physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with malunion is a billable ICD-10-CM diagnosis code (S49.049P).
7th character	The appropriate 7th character is to be added to each code from subcategories S49.0 and S49.1	The appropriate 7th character is to be added to each code from subcategories S49.0 and S49.1
Includes	injuries of axilla injuries of scapular region	injuries of axilla injuries of scapular region

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Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources