Is S92.401B a billable ICD-10-CM code?

Yes. S92.401B is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does S92.401B sit in the tabular list?

Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the ankle and foot (S90-S99).

S92.401B

S92.401B — Displaced unspecified fracture of right great toe, initial encounter for open fracture

Billable / specific codeICD-10-CMright

S92.401B is a billable, specific ICD-10-CM code for displaced unspecified fracture of right great toe, initial encounter for open fracture. It is valid for submission on a claim.

7th character "B" — initial encounter for open fracture

The appropriate 7th character is to be added to each code from category S92

A: initial encounter for closed fracture
B: initial encounter for open 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

Excludes2 inherited from the categories above S92.401B

Also inherited, and the opposite of Excludes1: these conditions are not part of S92.401B, but a patient can have both, so you may code both.

Written on S92.4 — Fracture of great toe

Physeal fracture of phalanx of toe (S99.2-)

Written on S92 — Fracture of foot and toe, except ankle

fracture of ankle (S82.-)
fracture of malleolus (S82.-)
traumatic amputation of ankle and foot (S98.-)

Other codes that can never be billed with S92.401B

These codes carry an Excludes1 note pointing at S92.401B. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading S92.401B alone.

M84.3Stress fracture
M84.4Pathological fracture, not elsewhere classified
S91Open wound of ankle, foot and toes

Risk adjustment

S92.401B 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

S92.401B is named in 4 Medicare coverage policies — 4 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A53058Billing and Coding: Home Health Physical Therapy
A53065Billing and Coding: Outpatient Physical Therapy
A54767Billing and Coding: Medicare Preventive Coverage for Certain Vaccines
A57311Billing and Coding: Physical Therapy - Home Health

Code history

S92.401B has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share S92.401. If S92.401B is not quite right, the correct code is usually one of these.

Questions about S92.401B

Is S92.401B a billable ICD-10-CM code?: Yes. S92.401B is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does S92.401B sit in the tabular list?: Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the ankle and foot (S90-S99).