Is S52.099R a billable ICD-10-CM code?

Yes. S52.099R is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does S52.099R sit in the tabular list?

Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the elbow and forearm (S50-S59).

S52.099R

S52.099R — Other fracture of upper end of unspecified ulna, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

Billable / specific codeICD-10-CMPOA exempt

S52.099R is a billable, specific ICD-10-CM code for other fracture of upper end of unspecified ulna, subsequent encounter for open fracture type iiia, iiib, or iiic with malunion. It is valid for submission on a claim.

7th character "R" — subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

The appropriate 7th character is to be added to all codes from category S52

A: initial encounter for closed fracture
B: initial encounter for open fracture type I or II
C: initial encounter for open fracture type IIIA, IIIB, or IIIC
D: subsequent encounter for closed fracture with routine healing
E: subsequent encounter for open fracture type I or II with routine healing
F: subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
G: subsequent encounter for closed fracture with delayed healing
H: subsequent encounter for open fracture type I or II with delayed healing
J: subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
K: subsequent encounter for closed fracture with nonunion
M: subsequent encounter for open fracture type I or II with nonunion
N: subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
P: subsequent encounter for closed fracture with malunion
Q: subsequent encounter for open fracture type I or II with malunion
R: subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S: sequela

Risk adjustment

S52.099R 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

S52.099R 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 S52.099. If S52.099R is not quite right, the correct code is usually one of these.

Questions about S52.099R

Is S52.099R a billable ICD-10-CM code?: Yes. S52.099R is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does S52.099R sit in the tabular list?: Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the elbow and forearm (S50-S59).