S92.405A — Nondisplaced unspecified fracture of left great toe, initial encounter for closed fracture
S92.405A is a billable, specific ICD-10-CM code for nondisplaced unspecified fracture of left great toe, 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 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
Risk adjustment
S92.405A 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
S92.405A is named in 3 Medicare coverage policies — 3 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
- A57311Billing and Coding: Physical Therapy - Home Health
Related codes at this level
Codes that share S92.405. If S92.405A is not quite right, the correct code is usually one of these.
- S92.405BNondisplaced unspecified fracture of left great toe, initial encounter for open fracture
- S92.405DNondisplaced unspecified fracture of left great toe, subsequent encounter for fracture with routine healing
- S92.405GNondisplaced unspecified fracture of left great toe, subsequent encounter for fracture with delayed healing
- S92.405KNondisplaced unspecified fracture of left great toe, subsequent encounter for fracture with nonunion
- S92.405PNondisplaced unspecified fracture of left great toe, subsequent encounter for fracture with malunion
- S92.405SNondisplaced unspecified fracture of left great toe, sequela
Questions about S92.405A
- Is S92.405A a billable ICD-10-CM code?
- Yes. S92.405A is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does S92.405A 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).