Is S92.406S a billable ICD-10-CM code?

Yes. S92.406S is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does S92.406S 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).

S92.406S

S92.406S — Nondisplaced unspecified fracture of unspecified great toe, sequela

Billable / specific codeICD-10-CMPOA exempt

S92.406S is a billable, specific ICD-10-CM code for nondisplaced unspecified fracture of unspecified great toe, sequela. It is valid for submission on a claim.

7th character "S" — sequela

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 S92.406S

Also inherited, and the opposite of Excludes1: these conditions are not part of S92.406S, 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 S92.406S

These codes carry an Excludes1 note pointing at S92.406S. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading S92.406S alone.

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

Risk adjustment

S92.406S 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

S92.406S 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.

A53064Billing and Coding: Outpatient Occupational Therapy

Code history

S92.406S 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 S92.406. If S92.406S is not quite right, the correct code is usually one of these.

Questions about S92.406S

Is S92.406S a billable ICD-10-CM code?: Yes. S92.406S is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does S92.406S 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).