ICD-10 Code S35.492S: Other specified injury of left renal artery, sequela

Key takeaways

ICD-10 code S35.492S covers other specified injury of the left renal artery, sequela.

It is billable for FY2026, effective October 1, 2025, on both inpatient and outpatient claims.

The 7th character S marks a sequela encounter, so the code is never sequenced first on a claim.

When the record names the left renal artery, use S35.492S rather than S35.491S or S35.493S.

Practice management software like Pabau keeps the trauma note and every follow-up visit on one record, so coders can trace causality.

ICD-10 code S35.492S is a billable diagnosis code for other specified injury of the left renal artery, sequela. It applies once the original injury has resolved and a late complication has become the reason for care. Renovascular hypertension is the most common of those complications.

The 7th character S marks that phase of care, and it also fixes where the code sits on the claim. A sequela code never leads. This reference covers the code’s definition, billable status, 7th character rules, hierarchy, sibling codes, and FY2026 DRG context. Code descriptors follow the CMS ICD-10-CM code set.

ICD-10 code S35.492S: definition, billable status, and FY2026 validity

S35.492S is a billable, specific ICD-10-CM code in the FY2026 edition, effective October 1, 2025. The official description is other specified injury of left renal artery, sequela. It supports a diagnosis for reimbursement on both inpatient and outpatient claims.

The code belongs to the American ICD-10-CM version of the classification and is distinct from the international ICD-10 maintained by the World Health Organization. For US payers and Medicare, always reference the CMS/NCHS ICD-10-CM tabular list rather than the WHO browser.

Clinical documentation may phrase this diagnosis differently. Coders meet these variants in discharge summaries and operative notes when working the alphabetic index.

• Left renal artery injury sequela
• Late effect of left renal artery trauma
• Sequela of left renal vascular injury

Understanding the 7th character: S35.492A, S35.492D, and S35.492S

The parent code S35.492 needs a 7th character to be complete and billable. Three extensions are available, and each one reflects a different phase of the encounter. Picking the wrong character is a common error in trauma claims, especially at the handover from acute to follow-up care.

The 7th character does not describe the injury. It describes the phase of care at the current encounter. A patient whose left renal artery injury has healed, and who now presents with renovascular hypertension, is coded S35.492S rather than S35.492D.

When to use S35.492S: ICD-10-CM sequela coding guidelines

Sequela coding follows Section I.C.19.a of the ICD-10-CM Official Guidelines. Those rules apply directly to S35.492S.

• Sequela means the late effect of a previous injury. The original left renal artery trauma has healed, or is no longer the active problem. The current encounter addresses a complication that arose from it.
• Two codes are usually required. Assign the nature-of-sequela code first, such as renovascular hypertension I15.0. Then assign S35.492S to identify the original injury as the cause.
• No time threshold applies. No fixed period turns an injury into a sequela. What matters is whether the original injury is still active or healing. When it is neither, and a new condition has developed from it, the S character applies.
• The S character is not for active injury encounters. If the patient is still being treated for the original injury, use S35.492A or S35.492D.
• External cause codes follow suit. When a V, W, X, or Y code applies, give it the S character too in a sequela encounter.

The physician’s note has to identify the current condition as a consequence of the prior injury. Wording such as “history of renal artery injury”, with nothing linking it to the current problem, will not support S35.492S. A medical chart audit is usually where that missing link surfaces.

Code hierarchy: where S35.492S sits in ICD-10-CM

The hierarchy shows where the code sits in the tabular list, and which parent levels are not billable. S35.492S is the most specific billable code in its branch.

The parent code S35.492 is not billable on its own, and a claim carrying it will be rejected. Verify all seven characters before submission. The AAPC Codify ICD-10-CM lookup lets you walk the full S35 hierarchy when you need to confirm a neighboring code.

Sibling codes in the S35.4 renal vessel family

Coders working left renal artery injuries need the whole S35.49 family, plus the wider renal vessel set. Picking the wrong laterality, or the wrong specificity level, is a common audit trigger. Neighboring vessels in the same category carry their own codes, including S35.10XD for the inferior vena cava.

Laterality matters. An auditor will flag a claim where the notes describe the left renal artery but the code names the right. The same happens when the code falls back on the unspecified variant. Where the report names the left renal artery, S35.492S is correct rather than S35.491S or S35.493S.

Keeping the operative report, the imaging, and the coded diagnosis in one clinical record lets the coder confirm the side without chasing paperwork.

Clinical context: left renal artery injuries and their sequelae

The left renal artery branches directly off the abdominal aorta and supplies the left kidney. It is vulnerable to blunt trauma, penetrating injury, and iatrogenic damage during retroperitoneal procedures. Knowing which sequelae are common helps coders check that the nature-of-sequela code is specific enough.

Common mechanisms of original injury

• High-speed blunt abdominal trauma (motor vehicle collisions, falls from height)
• Penetrating trauma (stab wounds, gunshot wounds to the flank or retroperitoneum)
• Iatrogenic injury during nephrectomy, ureteral surgery, or abdominal aortic aneurysm repair, which can also bruise the adrenal gland (S37.812A)
• Blunt deceleration injury causing intimal tear or thrombosis

Late-effect presentations that drive S35.492S encounters

• Renovascular hypertension: The most commonly coded sequela. Renal artery stenosis or fibrosis following injury activates the renin-angiotensin system, producing secondary hypertension. Code the hypertension first (I15.0), then S35.492S.
• Renal atrophy: Chronic ischemia from post-traumatic arterial narrowing causes progressive kidney size reduction. Assign the atrophy code followed by S35.492S.
• Renal artery pseudoaneurysm: A late vascular complication that may require endovascular repair months after the initial injury. The procedural encounter would reference the pseudoaneurysm as the primary diagnosis with S35.492S as the underlying cause.
• Chronic renal insufficiency: When post-traumatic ischemia progresses to CKD, the CKD stage code precedes S35.492S.

Documentation that traces these late presentations back to the original vascular injury is what makes S35.492S defensible. Without that documented chain, the code cannot be sustained on review. Sports medicine practices tend to see the blunt-trauma cases first. Longer-term blood pressure and kidney function follow-up often lands with metabolic health teams instead.

DRG and reimbursement considerations for S35.492S

For inpatient admissions, S35.492S falls under Major Diagnostic Category (MDC) 21, Injuries, Poisonings and Toxic Effects of Drugs. FY2026 claims group through MS-DRG grouper version 43.0, which CMS updated to version 43.1 effective April 1, 2026. The specific DRG depends on documented complications and comorbidities (CC/MCC).

Sequela encounters are usually outpatient, such as a follow-up visit to manage renovascular hypertension. DRG assignment therefore matters less here than it does for the S35.492A initial encounter.

It does matter when a late complication drives an admission, such as endovascular repair of a post-traumatic pseudoaneurysm. Always pull the current CMS IPPS tables for FY2026 relative weights, since weights change every year. Practice management workflows that prompt for the causal statement help coders sequence the pair correctly before the grouper runs.

Common coding errors with S35.492S

The sequela character generates more coder queries than the initial or subsequent characters, simply because vascular trauma reaches this phase less often. These are the patterns that produce claim problems.

Sequencing error: placing S35.492S first

ICD-10-CM guidelines put the nature-of-sequela code first, such as renovascular hypertension I15.0. S35.492S follows it as the cause code. Leading with S35.492S reverses that order, which can trigger a rejection or a medical necessity denial. Code the condition being treated today first.

Confusing subsequent encounter with sequela

A patient who returns six months after left renal artery repair for a wound check is still in subsequent encounter territory. That visit takes S35.492D. The S character applies only once the original injury has resolved and a new complication drives the encounter. Defaulting to S for any late visit misapplies the guideline.

Using the unspecified code when laterality is documented

Submitting S35.493S for an unspecified renal artery, when the record clearly names the left side, is an avoidable specificity error. Payers score claims on diagnosis specificity, and an unspecified code can flag the claim for review. Check laterality against the operative report or imaging before you reach for S35.493S.

Missing the external cause code in sequela encounters

When you code the sequela of a traumatic injury, the external cause code should also carry the S character. Omitting it, or using it without the S extension, leaves the claim record incomplete. Generating the follow-up patient letter from the visit note keeps the mechanism of injury visible in the record.

How Pabau keeps sequela documentation audit-ready

In many practices the evidence for a sequela code sits in three places. The operative note is in one system and the follow-up visit is in another. The coder then works from a discharge summary that never states the link.

Practice management software like Pabau keeps that chain on a single patient record. The trauma note, the imaging report, and every follow-up visit stay attached to the same timeline. Digital intake forms can make the injury date and mechanism required fields, so the external cause is captured before the appointment starts.

Pabau Scribe, our AI scribe, drafts the follow-up note from the consultation itself. The causal sentence an auditor looks for gets written while the clinician is still with the patient. Compliance tools then log who changed each record, and when.

The result is a chart that supports S35.492S on its own, without a retrospective query to the physician weeks after the visit.

Keep sequela documentation audit-ready

Pabau holds the trauma note, the imaging, and every follow-up visit on one patient record. Coders can trace the causal link behind a sequela code without chasing paperwork.

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Conclusion

The hard part of S35.492S is rarely the code itself. What decides the claim is whether the note says the current problem came from the old injury. Seven correct characters will not rescue a chart that never makes the connection.

So raise the query before the claim goes out, not after the denial lands. One sentence naming the original injury and its date turns a contested code into a defensible one. Across a year of follow-up visits, that habit is worth more than any code lookup.

Structured records are what make the habit stick. Book a demo to see how Pabau links follow-up visits back to the original injury for cleaner ICD-10 documentation.

Continue your research

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Coding a vessel injury in the chest? S25.509A covers an intercostal blood vessel injury at the initial encounter.

Want to know how your coding holds up on review? Medical chart audit walks through what reviewers look for in a clinical record.

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