S49.099A — Other physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture
S49.099A is a billable, specific ICD-10-CM code for other physeal fracture of upper end of humerus, unspecified arm, initial encounter for closed fracture. It is valid for submission on a claim.
7th character "A" — initial encounter for closed fracture
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
Risk adjustment
S49.099A does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
S49.099A is named in 1 Medicare coverage policy — 1 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A53065Billing and Coding: Outpatient Physical Therapy
Related codes at this level
Codes that share S49.099. If S49.099A is not quite right, the correct code is usually one of these.
- S49.099DOther physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with routine healing
- S49.099GOther physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with delayed healing
- S49.099KOther physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with nonunion
- S49.099POther physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with malunion
- S49.099SOther physeal fracture of upper end of humerus, unspecified arm, sequela
Questions about S49.099A
- Is S49.099A a billable ICD-10-CM code?
- Yes. S49.099A is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does S49.099A sit in the tabular list?
- Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the shoulder and upper arm (S40-S49).