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S49.149 ICD-10-CM Code: Salter-Harris Type IV physeal fracture of lower end of humerus, unspecified arm

Billing Status: NO. This is a clinician non-billable / parent hierarchy grouping in the ICD-10-CM system.

Coding at a Glance

7th character
Required — see the character table on this page
Tabular directives
2 inclusion terms · 4 Excludes2

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for S49.149 in the official ICD-10-CM tabular list, quoted as published.

Notes without a marker are published on S49.149 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • injuries of axilla
  • injuries of scapular region

Source: inherited from S40-S49

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from S40-S49

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
  • 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

S49.149A, S49.149D, S49.149G, S49.149K, S49.149P, S49.149S

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 S49.149

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

Before you code S49.149

  1. S49.149 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

    ReviewS49.149A, S49.149D, S49.149G, S49.149K, S49.149P, S49.149S

    See the relationships section · Guide: How to choose an ICD-10-CM code →

  2. Unspecified does not mean incorrect. When the record gives no greater specificity, S49.149 may be the appropriate code. Check the record for detail that supports a more specific sibling. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

    ReviewS49.141, S49.142

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

  3. A 7th character is required in this family. Confirm the documented encounter: initial (active treatment), subsequent (healing or recovery phase), or sequela. S49.149 is not valid without one. “Initial” means active treatment, not the first visit (Guidelines I.C.19.a).

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

  4. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: unspecified). 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).

    ReviewS49.141 · right, S49.142 · left

    Guide: Laterality coding →

  5. 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. Does the documentation support one of the more specific codes beneath S49.149?
    Yes → Select that code and continue the checks below on its own page.
    No → S49.149 cannot be reported as written; query for the specificity its subcategory needs.

    ReviewS49.149A, S49.149D, S49.149G, S49.149K, S49.149P, S49.149S

  2. Does the record document the detail a more specific sibling code needs?
    Yes → Review the specific siblings in this subcategory.
    No → Continue — S49.149 is appropriate when the documentation goes no further.

    ReviewS49.141, S49.142

  3. 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.

    ReviewS49.141 · right, S49.142 · left

  4. 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 S49.149. 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 S49.149(4 notes)

    Coding workflow: The conditions named in this note are not included in S49.149. 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

Documentation: The provider documents the condition in the terms of this code’s title and records no further detail.

Coding question: Is a more specific sibling code supportable?

Path: Review the specific siblings in this subcategory and what each requires the record to state.

Reason: A more specific code needs documentation of the distinguishing element; without it the unspecified code is appropriate, and a provider query is the route to specificity (Guidelines I.A.9.b, I.B.18).

ReviewS49.141, S49.142

Documentation: The patient returns during the healing or recovery phase after active treatment of the same condition.

Coding question: Which 7th character applies?

Path: Review the official 7th-character definitions for this family in the 7th Character Guide.

Reason: “Initial encounter” means active treatment, not the first visit; care during recovery takes “subsequent encounter”, and a complication arising from the original condition takes “sequela” (Guidelines I.C.19.a).

Documentation: The record documents the condition on one side only.

Coding question: Which code in this family applies?

Path: Select the sibling code for the documented side.

Reason: Laterality is assigned from the documented side; the unspecified-side code is for records that state no side (Guidelines I.B.13).

ReviewS49.141 · right, S49.142 · left

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.

Code Overview

Salter-Harris Type IV physeal fracture of lower end of humerus, unspecified arm is a non-billable ICD-10-CM category code (S49.149). A more specific billable subcode must be selected for claims submission.

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Verify Before Coding

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 S49.149 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: S42.3 — Fracture of shaft of humerus (via S49.1.-), S42.4 — Fracture of lower end of humerus (via S49.1.-).

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

Related Codes

Same condition, opposite side

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

S49.141 — Salter-Harris Type IV physeal fracture of lower end of humerus, right arm (right)Compare S49.149 vs S49.141 →, S49.142 — Salter-Harris Type IV physeal fracture of lower end of humerus, left arm (left)Compare S49.149 vs S49.142 →

Contextual Map

Every relationship of S49.149 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 S49.149 with these 2 related codes in Claim Check

Hierarchy

Referenced by Excludes2 notes

Nearest codes (40)

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

Can S49.149 be billed directly?

No. S49.149 (Salter-Harris Type IV physeal fracture of lower end of humerus, unspecified arm) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

Does S49.149 require a 7th character?

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

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
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) 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

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Salter-Harris Type IV physeal fracture of lower end of humerus, unspecified arm

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to S49.149 in its code family, with their registry titles.

View all codes in the S49 family