Is S49.1 a billable ICD-10-CM code?

No. S49.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does S49.1 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).

S49.1

S49.1 — Physeal fracture of lower end of humerus

Non-billable headerICD-10-CM

S49.1 is a non-billable header ICD-10-CM code for physeal fracture of lower end of humerus. It cannot be billed on its own: choose one of the more specific child codes below. This code also requires a 7th character before it is complete.

This code requires a 7th character

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

S49.1 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.

Code to one of these instead S49.1

6 child codes. Green means billable.

Related codes at this level

Codes that share S49. If S49.1 is not quite right, the correct code is usually one of these.

Questions about S49.1

Is S49.1 a billable ICD-10-CM code?: No. S49.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does S49.1 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).