S49.099A (Other physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture) compared with S49.099S (Other physeal fracture of upper end of humerus, unspecified arm, sequela), from the official CMS tabular data. S49.099A and S49.099S code the same injury at a different phase of treatment.
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
Same injury, other encounter phase. S49.099A and S49.099S 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.
| S49.099AOther physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture | S49.099SOther physeal fracture of upper end of humerus, unspecified arm, sequela | |
|---|---|---|
| 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 | Other physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture is a billable ICD-10-CM diagnosis code (S49.099A). | Other physeal fracture of upper end of humerus, unspecified arm, sequela is a billable ICD-10-CM diagnosis code (S49.099S). |
| 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 |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources