S49.092A ICD-10-CM Code: Other physeal fracture of upper end of humerus, left arm, initial encounter for closed fracture

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for S49.092A in the official ICD-10-CM tabular list, quoted as published.

Notes without a marker are published on S49.092A itself; “inherited from” names the category or block whose note applies here.

7th Character Guide

"The appropriate 7th character is to be added to each code from subcategories S49.0 and S49.1"

• A — initial encounter for closed fracture (this page’s code)
• D — subsequent encounter for fracture with routine healing
• G — subsequent encounter for fracture with delayed healing
• K — subsequent encounter for fracture with nonunion
• P — subsequent encounter for fracture with malunion
• S — sequela

How the encounter character is assigned. “Initial encounter” means the patient is receiving active treatment for the condition — it is not limited to the first visit, and a different or new provider giving active treatment still assigns it. “Subsequent encounter” covers care during the healing or recovery phase after active treatment. “Sequela” is for complications or conditions that arise as a direct result of the original condition.

ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19.a (paraphrased by MedCoder).

Variant codes in this family

S49.092A, S49.092D, S49.092G, S49.092K, S49.092P, S49.092S

Character meanings are CMS's official 7th-character extensions for this family, as carried in each variant code's official description; variant codes are registry rows. The explanation of how the encounter character is assigned is MedCoder editorial, distinct from the official content above it.

Coder workflow for S49.092A

MedCoder structured workflow — derived from this code’s own official record

Before you code S49.092A

1. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on S49.092A; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

   See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

2. A 7th character is required in this family. Confirm the documented encounter: initial (active treatment), subsequent (healing or recovery phase), or sequela. This page’s code carries “A”. “Initial” means active treatment, not the first visit (Guidelines I.C.19.a).

   See the 7th Character Guide · Guide: 7th characters: initial, subsequent, sequela →

3. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: left). The unspecified-side code applies only when the record states no side. Laterality is assigned from the documented side; where a bilateral code exists and both sides are documented, it is used instead of two unilateral codes (Guidelines I.B.13).

   ReviewS49.091A · right, S49.099A · unspecified

   Guide: Laterality coding →

4. Confirm the injury type, the anatomical site at the most specific level documented, laterality where the family codes it, and the encounter for the 7th character. Each injury is coded separately unless the classification provides a combination code, and a superficial injury is not coded when a more severe injury of the same site is documented. A fracture not documented as open or closed is coded as closed; one not documented as displaced or nondisplaced is coded as displaced. Injury chapter guidelines (Guidelines I.C.19.b, I.C.19.b.1, I.C.19.c).

   Guide: Traumatic vs pathological vs stress fracture →

Choose the right path

1. Is the side documented?
   Yes → Select the code for the documented side (or the bilateral code when both sides are documented and one exists).
   No → Use the unspecified-side code only when the record states no side; a query is the alternative.

   ReviewS49.091A · right, S49.099A · unspecified

2. Is the encounter phase documented — active treatment, healing or recovery, or a sequela?
   Yes → Assign the matching 7th character; the variant codes are in the 7th Character Guide.
   No → The code is invalid without its 7th character — query for the missing element.

Consider S49.092A. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Anatomical site

At the most specific level the record states; a site the classification separates cannot be assumed from a procedure or a measurement.

Laterality

Right, left or bilateral as documented; unspecified only when the record states no side (Guidelines I.B.13).

Encounter type

Active treatment, healing or recovery phase, or sequela — the basis of the 7th character (Guidelines I.C.19.a).

Open or closed; displaced or nondisplaced

Defaults apply when the record is silent: closed, and displaced (Guidelines I.C.19.c).

External cause, place and activity

For the external cause codes reported with the injury or poisoning, where documented (Guidelines I.C.20.a).

Any detail beyond this code’s title

What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

• Excludes2 — not part of S49.092A(4 notes)

  Coding workflow: The conditions named in this note are not included in S49.092A. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareT63.4

  See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Don’t confuse S49.092A with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of S49.092A — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• S49.091A— Laterality relationship (Review)

  Same condition; these differ only in which side is documented.

  The same condition on the other side; the documented side decides, and a bilateral code, where one exists, replaces the pair when both sides are documented.

  What moves you there: A documented right side moves the case to S49.091A.

  Full comparison: S49.092A vs S49.091A →

• S49.099A— Laterality relationship (Review)

  Same condition; these differ only in which side is documented.

  The same condition on the other side; the documented side decides, and a bilateral code, where one exists, replaces the pair when both sides are documented.

  What moves you there: A record that states no side takes S49.099A; a documented side moves it back to a sided code.

  Full comparison: S49.092A vs S49.099A →

• S49.092D— Encounter relationship (Review)

  Same underlying diagnosis, different encounter phase.

  The same diagnosis at a different phase of care; one encounter takes one 7th character.

  What moves you there: Documentation of a subsequent encounter for fracture with routine healing moves the case to S49.092D.

  Full comparison: S49.092A vs S49.092D →

• S49.092G— Encounter relationship (Review)

  Same underlying diagnosis, different encounter phase.

  The same diagnosis at a different phase of care; one encounter takes one 7th character.

  What moves you there: Documentation of a subsequent encounter for fracture with delayed healing moves the case to S49.092G.

  Full comparison: S49.092A vs S49.092G →

• T20— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of burns and corrosions adds T20; it is not part of this code and both may be reported when both are documented.

  Full comparison: S49.092A vs T20 →

• T32— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of burns and corrosions adds T32; it is not part of this code and both may be reported when both are documented.

  Full comparison: S49.092A vs T32 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

1. A 7th character applies in this family. Confirm the documented encounter matches the character assigned. See the official 7th-character definitions and this code’s variants
2. Laterality is coded in this family. Confirm the documented side matches the code — the opposite-side siblings are in the relationships section. See the opposite-side sibling codes
3. 4 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

• CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name S49.092A or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 2 Excludes2 notes: S42.2 — Fracture of upper end of humerus (via S49.0.-), S42.3 — Fracture of shaft of humerus (via S49.0.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 251 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 5 MS-DRGs: DRG 562 (MDC 08), DRG 563 (MDC 08), DRG 963 (MDC 24), DRG 964 (MDC 24), DRG 965 (MDC 24).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):INJ004 — Fracture of the upper limb, initial encounter (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

S49.002A — Unspecified physeal fracture of upper end of humerus, left arm, initial encounter for closed fracture, S49.009A — Unspecified physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture, S49.012A — Salter-Harris Type I physeal fracture of upper end of humerus, left arm, initial encounter for closed fracture, S49.019A — Salter-Harris Type I physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture, S49.022A — Salter-Harris Type II physeal fracture of upper end of humerus, left arm, initial encounter for closed fracture, S49.029A — Salter-Harris Type II physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture, S49.032A — Salter-Harris Type III physeal fracture of upper end of humerus, left arm, initial encounter for closed fracture, S49.039A — Salter-Harris Type III physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture, S49.042A — Salter-Harris Type IV physeal fracture of upper end of humerus, left arm, initial encounter for closed fracture, S49.049A — Salter-Harris Type IV physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture, S49.099A — Other physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture, S49.102A — Unspecified physeal fracture of lower end of humerus, left arm, initial encounter for closed fracture, S49.109A — Unspecified physeal fracture of lower end of humerus, unspecified arm, initial encounter for closed fracture, S49.112A — Salter-Harris Type I physeal fracture of lower end of humerus, left arm, initial encounter for closed fracture, S49.119A — Salter-Harris Type I physeal fracture of lower end of humerus, unspecified arm, initial encounter for closed fracture, S49.122A — Salter-Harris Type II physeal fracture of lower end of humerus, left arm, initial encounter for closed fracture, S49.129A — Salter-Harris Type II physeal fracture of lower end of humerus, unspecified arm, initial encounter for closed fracture, S49.132A — Salter-Harris Type III physeal fracture of lower end of humerus, left arm, initial encounter for closed fracture, S49.139A — Salter-Harris Type III physeal fracture of lower end of humerus, unspecified arm, initial encounter for closed fracture, S49.142A — Salter-Harris Type IV physeal fracture of lower end of humerus, left arm, initial encounter for closed fracture, +230 more

Same condition, opposite side

Same category and title, differing only in which side of the body is affected.

S49.091A — Other physeal fracture of upper end of humerus, right arm, initial encounter for closed fracture (right)Compare S49.092A vs S49.091A →, S49.099A — Other physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture (unspecified)Compare S49.092A vs S49.099A →

Same injury, other encounter phase

Same injury, coded at a different phase of treatment via the 7th character.

S49.092D — Other physeal fracture of upper end of humerus, left arm, subsequent encounter for fracture with routine healingCompare S49.092A vs S49.092D →, S49.092G — Other physeal fracture of upper end of humerus, left arm, subsequent encounter for fracture with delayed healingCompare S49.092A vs S49.092G →, S49.092K — Other physeal fracture of upper end of humerus, left arm, subsequent encounter for fracture with nonunionCompare S49.092A vs S49.092K →, S49.092P — Other physeal fracture of upper end of humerus, left arm, subsequent encounter for fracture with malunionCompare S49.092A vs S49.092P →, S49.092S — Other physeal fracture of upper end of humerus, left arm, sequelaCompare S49.092A vs S49.092S →

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Fracture of the upper limb, initial encounter).

+1554 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Partial Thromboplastin Time (PTT) Test, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of S49.092A in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run S49.092A with these 2 related codes in Claim Check

Hierarchy

• S00-T88 — Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) (S00-T88)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• S40-S49 — Injuries to the shoulder and upper arm[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes2 notes

• S42.2 — Fracture of upper end of humerus[Excludes2](via S49.0.-): “physeal fracture of upper end of humerus (S49.0-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• S42.3 — Fracture of shaft of humerus[Excludes2](via S49.0.-): “physeal fractures of upper end of humerus (S49.0-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• INJ004 — Fracture of the upper limb, initial encounter[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
• DRG 562 — FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC[MS-DRG]: “FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC (MDC 08)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 563 — FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC[MS-DRG]: “FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC (MDC 08)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 963 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC[MS-DRG]: “OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC (MDC 24)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 964 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC[MS-DRG]: “OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC (MDC 24)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 965 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC[MS-DRG]: “OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC (MDC 24)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 08 — Diseases and Disorders of the Musculoskeletal System and Connective Tissue[MDC crossing]: “Diseases and Disorders of the Musculoskeletal System and Connective Tissue — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 18,508 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026
• MDC 24 — Multiple Significant Trauma[MDC crossing]: “Multiple Significant Trauma — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 22,957 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Nearest codes (40)

• S49 — Other and unspecified injuries of shoulder and upper arm[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• S49.042G — Salter-Harris Type IV physeal fracture of upper end of humerus, left arm, subsequent encounter for fracture with delayed healing[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• S49.042K — Salter-Harris Type IV physeal fracture of upper end of humerus, left arm, subsequent encounter for fracture with nonunion[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• S49.042P — Salter-Harris Type IV physeal fracture of upper end of humerus, left arm, subsequent encounter for fracture with malunion[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• S49.042S — Salter-Harris Type IV physeal fracture of upper end of humerus, left arm, sequela[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• S49.049 — Salter-Harris Type IV physeal fracture of upper end of humerus, unspecified arm[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• S49.049A — Salter-Harris Type IV physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• S49.049D — Salter-Harris Type IV physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with routine healing[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 32 more

Change history

• FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Common coding questions

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Coding guidelines Official source data

ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to S49.092A in its code family, with their registry titles.

• S49.091G — Other physeal fracture of upper end of humerus, right arm, subsequent encounter for fracture with delayed healing
• S49.091K — Other physeal fracture of upper end of humerus, right arm, subsequent encounter for fracture with nonunion
• S49.091P — Other physeal fracture of upper end of humerus, right arm, subsequent encounter for fracture with malunion
• S49.091S — Other physeal fracture of upper end of humerus, right arm, sequela
• S49.092 — Other physeal fracture of upper end of humerus, left arm
• S49.092D — Other physeal fracture of upper end of humerus, left arm, subsequent encounter for fracture with routine healing
• S49.092G — Other physeal fracture of upper end of humerus, left arm, subsequent encounter for fracture with delayed healing
• S49.092K — Other physeal fracture of upper end of humerus, left arm, subsequent encounter for fracture with nonunion
• S49.092P — Other physeal fracture of upper end of humerus, left arm, subsequent encounter for fracture with malunion
• S49.092S — Other physeal fracture of upper end of humerus, left arm, sequela

View all codes in the S49 family