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S99.249B ICD-10-CM Code: Salter-Harris Type IV physeal fracture of phalanx of unspecified toe, initial encounter for open fracture

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, Appendix B.

  • MS-DRG 913 — TRAUMATIC INJURY WITH MCC (MDC 21)
  • MS-DRG 914 — TRAUMATIC INJURY WITHOUT MCC (MDC 21)
  • MS-DRG 963 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC (MDC 24)
  • MS-DRG 964 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC (MDC 24)
  • MS-DRG 965 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC (MDC 24)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Official Registry Overview & Definition

Salter-Harris Type IV physeal fracture of phalanx of unspecified toe, initial encounter for open fracture is a billable ICD-10-CM diagnosis code (S99.249B).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for S99.249B in the official ICD-10-CM tabular list.

Excludes2 — Not Included Here

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

Frequently Compared Codes

The official Excludes notes on S99.249B name these codes. Each comparison page covers when the two can — or must not — be reported together.

Change history

  • FY2017 — 2016-10-01
    Added to the code set
    Salter-Harris Type IV physeal fracture of phalanx of unspecified toe, initial encounter for open fracture
    FY2017 changes

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

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

Relationships & Classification

Other codes that name S99.249B 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.

3 Excludes2 notes: S89 (via S99.-), S92.4 (via S99.2.-), S92.5 (via S99.2.-).

Potential MS-DRG Relationships (FY2026)

Not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity.

Named in the grouper logic of 5 MS-DRGs: DRG 913 (MDC 21), DRG 914 (MDC 21), 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):INJ005 — Fracture of the lower limb (except hip), 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 injury — initial / subsequent / sequela

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

S99.249A — Salter-Harris Type IV physeal fracture of phalanx of unspecified toe, initial encounter for closed fracture (initial encounter), S99.249D — Salter-Harris Type IV physeal fracture of phalanx of unspecified toe, subsequent encounter for fracture with routine healing (subsequent encounter), S99.249G — Salter-Harris Type IV physeal fracture of phalanx of unspecified toe, subsequent encounter for fracture with delayed healing (subsequent encounter), S99.249K — Salter-Harris Type IV physeal fracture of phalanx of unspecified toe, subsequent encounter for fracture with nonunion (subsequent encounter), S99.249P — Salter-Harris Type IV physeal fracture of phalanx of unspecified toe, subsequent encounter for fracture with malunion (subsequent encounter), S99.249S — Salter-Harris Type IV physeal fracture of phalanx of unspecified toe, sequela (sequela)

Same clinical category (CCSR)

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

+1430 more

Lab tests where this diagnosis supports Medicare coverage

Medicare's National Coverage Determinations list this diagnosis as medical justification for these lab tests.

Blood Glucose Test (lab test), Partial Thromboplastin Time (PTT) Test (lab test), Prothrombin Time Test and INR (PT/INR) (lab test)

Contextual Map

Every relationship of S99.249B 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.

Hierarchy

  • S00-T88 — Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) (S00-T88) [Hierarchy]
  • S90-S99 — Injuries to the ankle and foot [Hierarchy]

Referenced by Excludes2 notes

  • S89 — Other and unspecified injuries of lower leg [Excludes2](via S99.-): “other and unspecified injuries of ankle and foot (S99.-)” · check together
  • S92.4 — Fracture of great toe [Excludes2](via S99.2.-): “Physeal fracture of phalanx of toe (S99.2-)” · check together
  • S92.5 — Fracture of lesser toe(s) [Excludes2](via S99.2.-): “Physeal fracture of phalanx of toe (S99.2-)” · check together

Clinical classification (CCSR)

  • INJ005 — Fracture of the lower limb (except hip), initial encounter [CCSR]

Potential MS-DRG

  • DRG 913 — TRAUMATIC INJURY WITH MCC [MS-DRG]: “TRAUMATIC INJURY WITH MCC (MDC 21)”
  • DRG 914 — TRAUMATIC INJURY WITHOUT MCC [MS-DRG]: “TRAUMATIC INJURY WITHOUT MCC (MDC 21)”
  • DRG 963 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC [MS-DRG]: “OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC (MDC 24)”
  • DRG 964 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC [MS-DRG]: “OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC (MDC 24)”
  • DRG 965 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC [MS-DRG]: “OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC (MDC 24)”

MDC crossing · procedures (54986)

  • MDC 21 — Injuries, Poisonings and Toxic Effects of Drugs [MDC crossing]: “Injuries, Poisonings and Toxic Effects of Drugs — 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.”
  • 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.”
  • 0016070 — Bypass Cerebral Ventricle to Nasopharynx with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Nasopharynx with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • 0016071 — Bypass Cerebral Ventricle to Mastoid Sinus with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Mastoid Sinus with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • 0016072 — Bypass Cerebral Ventricle to Atrium with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Atrium with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • 0016073 — Bypass Cerebral Ventricle to Blood Vessel with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Blood Vessel with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • 0016074 — Bypass Cerebral Ventricle to Pleural Cavity with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Pleural Cavity with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • and 54981 more

Nearest codes (40)

  • S99 — Other and unspecified injuries of ankle and foot [Sibling]
  • S99.239S — Salter-Harris Type III physeal fracture of phalanx of unspecified toe, sequela [Sibling]
  • S99.24 — Salter-Harris Type IV physeal fracture of phalanx of toe [Sibling]
  • S99.241 — Salter-Harris Type IV physeal fracture of phalanx of right toe [Sibling]
  • S99.241A — Salter-Harris Type IV physeal fracture of phalanx of right toe, initial encounter for closed fracture [Sibling]
  • S99.241B — Salter-Harris Type IV physeal fracture of phalanx of right toe, initial encounter for open fracture [Sibling]
  • S99.241D — Salter-Harris Type IV physeal fracture of phalanx of right toe, subsequent encounter for fracture with routine healing [Sibling]
  • S99.241G — Salter-Harris Type IV physeal fracture of phalanx of right toe, subsequent encounter for fracture with delayed healing [Sibling]
  • and 32 more

Change history

  • FY2017 — Added to the code set [Change history]

Frequently Asked Questions (FAQ) & Clinical Guidance

Does S99.249B require a 7th character?

Yes. The appropriate 7th character is to be added to each code from subcategories S99.2.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to S99.249B in its code family, with their registry titles.

  • S99.242K — Salter-Harris Type IV physeal fracture of phalanx of left toe, subsequent encounter for fracture with nonunion
  • S99.242P — Salter-Harris Type IV physeal fracture of phalanx of left toe, subsequent encounter for fracture with malunion
  • S99.242S — Salter-Harris Type IV physeal fracture of phalanx of left toe, sequela
  • S99.249 — Salter-Harris Type IV physeal fracture of phalanx of unspecified toe
  • S99.249A — Salter-Harris Type IV physeal fracture of phalanx of unspecified toe, initial encounter for closed fracture
  • S99.249D — Salter-Harris Type IV physeal fracture of phalanx of unspecified toe, subsequent encounter for fracture with routine healing
  • S99.249G — Salter-Harris Type IV physeal fracture of phalanx of unspecified toe, subsequent encounter for fracture with delayed healing
  • S99.249K — Salter-Harris Type IV physeal fracture of phalanx of unspecified toe, subsequent encounter for fracture with nonunion
  • S99.249P — Salter-Harris Type IV physeal fracture of phalanx of unspecified toe, subsequent encounter for fracture with malunion
  • S99.249S — Salter-Harris Type IV physeal fracture of phalanx of unspecified toe, sequela

View all codes in the S99 family