ICD-10 code S32.492B: Open left acetabulum fracture

Key takeaways

ICD-10 code S32.492B covers an other specified fracture of the left acetabulum, coded at the initial encounter for an open fracture.

The 7th character B is mandatory here, and it means active treatment of a fracture with an open wound.

S32.492B is billable for FY2026 and valid on HIPAA-covered transactions, while its parent codes S32.49 and S32.4 are not.

Practice management software like Pabau stores operative notes, imaging, and consent in one client record, which speeds up documentation checks.

ICD-10 code S32.492B is the billable diagnosis code for other specified fracture of the left acetabulum, initial encounter for open fracture. In plain terms, the hip socket on the left is broken, a wound reaches the fracture site, and treatment is still active.

Three details in the record decide whether that code holds up. The side, the fracture type, and the treatment status all have to match the note. Change any one of them and you are looking at a different code.

One detail trips people up before they even reach the 7th character. An acetabular fracture is a pelvis injury, so it codes to S32, not to the femur codes in S72.

S32.492B covers one side, one fracture type, one encounter

The acetabulum is the cup-shaped socket of the pelvis that holds the head of the femur. Fractures here follow high-energy trauma, such as a car crash or a fall from height. The code you pick has to carry all seven characters.

Surgeons classify these injuries with the Judet-Letournel system, which names the column or wall involved. ICD-10-CM does not use those names directly. It sorts acetabular fractures by pattern and side first, then adds the 7th character for the encounter.

Other specified still needs detail in the note

“Other specified” does not mean vague, but rather that the note describes a pattern that falls outside the displaced and nondisplaced options in the tabular list. The detail is still there to code specifically.

Named patterns have their own codes, so check for one before you settle here. A nondisplaced dome fracture of the right acetabulum, for example, codes to S32.484A.

• S32.492x: the left acetabulum, which is what this code covers
• S32.491x: the mirror codes for the right side
• S32.499x: laterality that the record cannot confirm
• Open fracture: bone through the skin, or a wound that reaches the fracture site

Missing laterality follows the same logic further up the family. A nondisplaced anterior wall fracture with no side documented lands on S32.416A, which gives up specificity the chart often supports.

The 7th character B tells the payer two things

Every code in the S32 family needs a 7th character. It says whether the patient is in active treatment or follow-up care, and whether the fracture is open or closed. B covers active treatment of an open fracture.

Initial encounter does not mean the first visit. It means active fracture management is still under way. A wound check two weeks after fixation is still an initial encounter if the surgeon is treating the fracture.

The same extension turns up across the pelvis codes. An open lumbosacral fracture at the initial encounter, for instance, is S32.9XXB.

Sequela sits outside the healing sequence altogether. It describes a lasting effect once treatment is finished, which is how codes such as S33.8XXS are built.

Where S32.492B sits in the ICD-10-CM hierarchy

The parent levels explain why this code runs to seven characters. Per the CMS ICD-10 codes page, every S32 code belongs to the injury chapter, S00-T88.

Coders who spend their days in hip surgery reach for the S72 femur codes out of habit. The acetabulum belongs to the pelvis, so an acetabular fracture stays in S32 even when the hip joint takes the damage.

The code is billable, its parent codes are not

S32.492B is billable for FY2026 and valid on HIPAA-covered electronic transactions. S32.49 and S32.4 only classify the injury. A claim that carries either one instead of the full code comes straight back.

Effective dates are worth a glance too. The FY2026 edition took effect on October 1, 2025 and runs through September 30, 2026. The CDC/NCHS ICD-10-CM web tool confirms the current status of any code.

HIPAA requires the current-year edition on covered electronic transactions. Submitting a code from last year’s edition is a rejection, so teams handling HIPAA transactions refresh their code lists every October.

The related codes you will choose between

The S32.492 group runs through every encounter type for the same fracture, and laterality splits it three ways. The sibling you actually need is usually one character away, as this list from AAPC Codify shows.

Siblings elsewhere in S32.4 follow the same shape. S32.402K carries nonunion on a left acetabular fracture that the record never specified any further.

A, B, or D: Pick by treatment, not by visit number

Three codes account for most of the mix-ups: S32.492A, S32.492B, and S32.492D. Choosing between A and B turns on one question. Does the note document an open fracture?

B against D turns on a different question. While the surgeon is still managing the fracture, B stands. Once care shifts to watching it heal, D takes over.

A return appointment on its own does not move the code. Wound care on an open fracture site is active treatment. Later, when rehab picks the patient up, physical therapy notes carry the encounter type forward.

What the record has to show

Four elements have to be visible in the chart before this code goes on a claim. Miss one and you are relying on a payer not to ask.

• Laterality: the note names the left acetabulum. Imaging that says “left hip” supports it, but the treating clinician should name the structure.
• Fracture type: the description supports “other specified” rather than a displaced or nondisplaced pattern with its own code.
• Open fracture: an emergency department note, operative report, or trauma assessment records a wound reaching the fracture.
• Active treatment: the visit is part of fracture management, not a review of a fracture that has already healed.

Here is how that reads in a real chart. A cyclist arrives by ambulance after a collision with a car. The emergency note records an open left acetabular fracture with a posterior wound.

The operative report then describes a pattern the surgeon calls neither displaced nor nondisplaced. Two days later she returns for a wound check, still under the trauma team. Both encounters code to S32.492B.

Denials cluster around one habit instead. The open-fracture detail stays in the operative report, and the outpatient note never repeats it. Building laterality and fracture-type fields into intake forms fixes it at source, which is why sports medicine and orthopedic teams tend to standardize their templates.

How the claim moves, and where it snags

Follow one claim from the trauma bay to the payer and the weak points show themselves.

1. The emergency and operative notes record the injury, the side, and the wound.
2. The coder reads both, assigns S32.492B, and adds the codes that explain how the injury happened.
3. Surgical work is coded separately. Open treatment of an acetabular fracture maps to CPT 27226, 27227, or 27228, and anything without a listed code falls to 27299.
4. The claim leaves the practice with the insurer’s required fields attached, such as membership and authorization numbers.
5. Payer edits check that the diagnosis is billable and that it supports the procedure billed.

Timing causes more trouble than the code itself. Coding often happens before the operative report is signed, so the open-fracture detail arrives after the claim has already gone out.

Authorization is the other pinch point. Planned fixation and later reconstruction need an approval on file, and a prior authorization form that is ready to send saves a week of rework.

Before you submit: A five-point check

1. The note names the left acetabulum, and the imaging report agrees.
2. The record documents a wound reaching the fracture site.
3. The description supports “other specified” rather than a named pattern.
4. The 7th character is B, and the visit is active treatment.
5. Neither S32.4 nor S32.49 appears anywhere on the claim.

Four mistakes that send this code back

1. Wrong side. S32.491B is the right acetabulum. Cross-check the imaging, the operative note, and the discharge summary before you commit to a side.
2. Wrong 7th character. A means closed and D means follow-up care, so either one contradicts an open fracture under active treatment.
3. Reaching for unspecified. S32.499B belongs to records that cannot confirm the pattern or the side. Where the note supports specificity, use it.
4. Billing a parent code. S32.4 and S32.49 classify the injury. They do not bill, and a payer will not pay them.

Sequencing deserves a second look on multi-trauma cases. When a patient carries several pelvic injuries, the official ICD-10-CM guidelines set the order. The condition chiefly responsible for the admission is listed first.

How Pabau keeps fracture records and claims together

In most trauma workflows the pieces of an S32.492B claim live in different places. The emergency note is in one system, the images in another, the consent on paper. The coder chases all three.

Pabau, an all-in-one practice management system, keeps them together instead. Treatment notes, imaging, consent forms, and visit history all sit against the patient record. Laterality and open-fracture status are then two clicks away, rather than two systems away.

On the billing side, our claims management checks the fields an insurer requires before a claim is sent, such as membership numbers and authorization codes. Code selection stays with your coder, where it belongs.

The outcome is less chasing. Fewer claims come back for missing information. An audit request is easier to answer too, because the note, the image, and the consent hang off the same encounter.

Keep fracture documentation in one place

Pabau brings client records, treatment notes, imaging, and claims into a single platform. Orthopedic and trauma teams use it to find the documentation behind a fracture claim in seconds, instead of chasing three systems.

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Conclusion

Coding an open acetabular fracture is a documentation job more than a lookup job. Once the note names the side, the pattern, and the treatment status, S32.492B takes seconds to assign.

So the work worth doing sits upstream of the coder. Put those four elements into the forms your team already completes, and nobody has to reconstruct the encounter a week later. A few extra fields at intake cost far less than a corrected claim.

Want the notes, images, and claim paperwork for a fracture in one place? Book a demo and see how Pabau handles it for orthopedic and trauma teams.

Continue your research

Coding a displaced column fracture instead? S32.432D walks through the anterior column of the left acetabulum at a follow-up visit.

Need the wider pelvis fracture picture? S32.9XXB covers an open lumbosacral fracture where the record does not name the part.

Still coding an injury that was treated months ago? S39.93XS shows how sequela coding works for pelvic injuries.

Tracking hip function after fixation? Harris Hip Score template gives you a scored record of pain, function, and range of motion.

Want to sharpen the assessment behind the note? Hip examination guide sets out the tests that support a clean clinical description.

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