ICD-10 code S49.102G: Physeal fracture, delayed healing

Key takeaways

ICD-10 code S49.102G is a billable FY2026 code for an unspecified physeal fracture of the lower end of the left humerus.

The lower end of the humerus sits at the elbow, not the shoulder, so S49.102G is not a proximal humerus code.

The 7th character ‘G’ means subsequent encounter with delayed healing. That is a different value from ‘D’, which means routine healing.

‘Unspecified’ means no Salter-Harris type was documented. Use S49.112, S49.122, S49.132, or S49.142 for the left arm when the type is known.

Practice management software like Pabau keeps imaging findings and encounter notes linked, so the 7th character you bill is the one the record supports.

ICD-10 code S49.102G is a billable ICD-10-CM diagnosis code, valid for HIPAA-covered transactions in fiscal year 2026. Its full description is: Unspecified physeal fracture of lower end of humerus, left arm, subsequent encounter for fracture with delayed healing.

Two details in that description cause most of the miscoding. The fracture sits at the lower (distal) end of the humerus, which is the elbow, not the shoulder. The 7th character “G” then reports delayed healing, which is not the same as the routine healing reported by “D”.

Pediatric orthopedic practices, emergency departments, and physical therapy teams all bill this code during follow-up care. Practice management software like Pabau helps those teams capture the encounter type and healing status at the visit. Pabau’s claims management software then carries that documentation through to the claim.

Code details at a glance

The table below lists the reference fields most often checked before an S49.102G claim goes out.

What ICD-10 code S49.102G means

S49.102G reports a follow-up visit for a growth plate fracture at the elbow end of the left humerus, where healing is running behind schedule. A physeal fracture is a break through the growth plate. That is the cartilaginous zone at the end of a long bone where new bone forms.

The lower end of the humerus forms the upper half of the elbow joint. It carries the capitellum, the trochlea, and the medial and lateral epicondyles. The distal humeral physis separates that articular block from the shaft while the skeleton is still growing.

The word “unspecified” in S49.102G means the treating provider did not document a Salter-Harris classification type. The Salter-Harris system grades physeal injuries from Type I, through the growth plate alone, to Type V, a crush injury of the plate. When imaging cannot confirm a type, coders use the unspecified code rather than implying a type nobody recorded.

These injuries are almost entirely pediatric, because an open growth plate is weaker than the bone and ligament around it. Distal humeral physeal separations are most often seen in very young children after a fall or a twisting force on the arm.

The CDC/NCHS ICD-10-CM classification places no age limit on the code. It may be assigned to any patient with an open physis at this site.

Approximate synonyms

The following terms describe the condition encoded by S49.102G. Coders may meet any of them in provider notes:

• Growth plate fracture of the distal humerus, left, with delayed union
• Epiphyseal fracture of the lower end of the left humerus, follow-up visit
• Salter-Harris fracture of the left distal humerus, type not stated
• Transphyseal separation of the left distal humerus, slow to heal
• Left elbow physeal injury, healing behind the expected timeline

Understanding the 7th character: What does “G” mean in an ICD-10 fracture code?

In a traumatic fracture code, “G” means subsequent encounter for fracture with delayed healing. The base code S49.102 covers the anatomy and the side. The 7th character then reports the encounter type and, for follow-up visits, the healing status.

Physeal fracture codes in S49 carry no open fracture characters. The available options are A, D, G, K, P, and S, so an open injury at this site is classified elsewhere in the tabular list.

Per the ICD-10-CM Official Guidelines maintained by CMS, a subsequent encounter is any visit after the patient has completed active treatment for the injury. ICD-10-CM does not set a number of weeks that defines delayed healing. The provider’s own statement is what supports the character you assign.

S49.102D vs S49.102G vs S49.102K: Sibling code comparison

Four sibling codes cover almost every follow-up decision on this injury. The table below sets out the clinical status each one asserts and the documentation a payer will expect behind it.

D and G cause the most trouble, since both sit at a subsequent encounter. What separates them is the claim each one makes about healing. D asserts that healing is on schedule. G asserts that it is behind schedule. Only one of those matches the note in front of you.

The G and K characters also need separating. Delayed healing still expects union to arrive. Nonunion says it has not arrived and is no longer expected.

Switching a patient from G to K mid-course is normal, and each claim should reflect the status recorded at that visit. Forearm codes such as S52.209K use the nonunion character in the same way.

Where the code sits in the ICD-10-CM hierarchy

Knowing where S49.102G sits in the tabular list makes it much easier to see when a more specific code applies.

• S00-T88: Injury, poisoning and certain other consequences of external causes
• S40-S49: Injuries to the shoulder and upper arm
• S49: Other and unspecified injuries of shoulder and upper arm (non-billable header)
• S49.1: Physeal fracture of lower end of humerus (non-billable header)
• S49.10: Unspecified physeal fracture of lower end of humerus (non-billable header)
• S49.102: Unspecified physeal fracture of lower end of humerus, left arm (non-billable, needs a 7th character)
• S49.102G: Subsequent encounter for fracture with delayed healing (billable)

S49, S49.1, and S49.10 are header codes and cannot be billed on their own. Only the six-character base plus a 7th character is valid on a claim.

The S49.0 versus S49.1 trap

The S49 category is titled “other and unspecified injuries of shoulder and upper arm”, which reads as though everything under it belongs near the shoulder. Only the S49.0 subcategory does. S49.0 is physeal fracture of the upper end of the humerus, and S49.1 is physeal fracture of the lower end, at the elbow.

One digit separates the two families, and their laterality digits behave the same way, so a transposition is easy to miss on review. The proximal counterpart of S49.102G is S49.002G. Typed injuries at that upper end, such as S49.032D, sit in the same S49.0 family.

So if the record describes a shoulder injury, the code should start S49.0, not S49.1.

Laterality within S49.10 follows the standard ICD-10-CM pattern. S49.101 is the right arm, S49.102 is the left arm, and S49.109 is the unspecified arm. Practices billing musculoskeletal follow-ups through sports medicine software should confirm the system appends the 7th character automatically. A dropped character is a leading denial cause in this family.

Documentation requirements for a delayed healing claim

Billing S49.102G without supporting documentation creates audit exposure. Four areas need to be covered in the clinical record before the claim is submitted.

Encounter type confirmation

The record has to show that this is a subsequent encounter rather than active treatment. A note giving the original injury date, the treatment already delivered, and the follow-up purpose of the current visit satisfies that test. The safer clinical notes framework sets out what a compliant follow-up entry contains.

Delayed healing evidence

Delayed healing has to be documented affirmatively, because the payer is being told the fracture is behind schedule. Acceptable supporting evidence includes:

• A radiograph report describing incomplete callus, a persistent fracture line, or absent bridging bone at the expected time point
• Provider wording such as “delayed union”, “slower than expected”, or “healing behind schedule”
• A comparison against the anticipated healing window for the patient’s age and fracture pattern
• A revised management plan, such as extended immobilization or a repeat imaging interval

Without that evidence, the claim rests on an assertion nobody in the record has made. Patient record management that timestamps imaging reports next to encounter notes closes that distance before the claim leaves the building.

Laterality and specificity

S49.102 is the left arm, so the word “left” should appear in both the diagnosis and the imaging report. Before settling on the unspecified code, check whether a Salter-Harris type was recorded. If the provider documented Type I, II, III, or IV, code S49.112, S49.122, S49.132, or S49.142 for the left arm instead.

Digital intake forms that capture the injury mechanism and imaging findings at first presentation make this check quick at every later visit. A type confirmed on later imaging still changes the code you submit at that visit.

External cause and POA reporting

Injury codes are usually reported alongside an external cause code describing how the fracture happened. In inpatient settings, S49.102G also needs a Present on Admission indicator, since it is not POA-exempt. Both are easy to drop at a follow-up visit, when the team’s attention is on the healing status.

Clinical context: Distal humerus physeal fractures

Physeal injuries at the lower end of the humerus usually follow a fall onto an outstretched arm. A direct blow to the elbow or a twisting force on the forearm can also cause them.

Transphyseal separation of the distal humerus is rare, and it is seen mostly in infants and toddlers. Clinicians are advised to consider non-accidental injury alongside the stated mechanism.

The elbow is difficult to read on plain film in young children. Much of the distal humerus is still cartilage, so it does not show up. That is part of why the unspecified code exists. A physeal injury can be confirmed clinically while the Salter-Harris type stays unclear until later imaging.

Most of these fractures are managed conservatively with immobilization, and most unite without difficulty. When union runs late, the follow-up plan usually extends immobilization and adds repeat imaging, which is exactly the encounter S49.102G describes. Delay at this site matters clinically, not only administratively. Poor healing at the distal humeral physis is associated with growth disturbance and cubitus varus.

Physical therapy teams also meet this code during rehabilitation. A patient with delayed union may attend for several months. The diagnosis on each claim should track the current status, not the one recorded at referral.

A separate injury at the same elbow gets its own code and its own 7th character. A displaced left olecranon fracture, for example, is reported as S52.022E.

How practice management software keeps the 7th character accurate

A delayed union generates a long tail of visits. The patient may return every few weeks for months, and the 7th character has to be reconsidered each time. Many teams handle that by having a coder read back through the notes. That is slow, and it goes wrong easily when imaging lives in a separate system.

Pabau keeps the clinical record and the billing record in the same place. The note, the imaging finding, and the diagnosis code all stay attached to the encounter they belong to. The coder sees the healing status the clinician documented. Three things follow from that:

• The right character on the right visit: Encounter-level records show whether a visit was initial, routine subsequent, or complicated. Teams stop defaulting to D when G or K applies.
• Evidence attached to the claim: Imaging reports and clinical notes stay linked to the encounter. Support for a delayed healing claim is retrievable in seconds, not reconstructed later.
• An audit trail across the episode: Practices working to HIPAA compliance requirements can show that each coding decision matched the record at the visit.

The result is fewer denials on codes where the anatomy and the healing status both have to be right. Orthopedic, sports medicine, and physical therapy EMR users all benefit from the same connection between what was documented and what was billed.

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Conclusion

S49.102G is a narrow code, and each part of it has to match the record. The site is the lower end of the humerus, at the elbow, not the shoulder. The side is left. The encounter is a follow-up, and the healing is documented as delayed rather than routine.

Get any one of those wrong and the claim is either denied or, worse, paid on a diagnosis the chart does not support. The two checks worth building into your workflow are the S49.0 versus S49.1 anatomy check and the D versus G healing check.

Pabau’s HIPAA-compliant documentation tools connect imaging reports, encounter notes, and diagnosis codes in one record, so the evidence behind codes like S49.102G is always audit-ready. To see how Pabau handles ICD-10 documentation and claims for orthopedic and physical therapy practices, book a demo.

Continue your research

Coding an open fracture at the elbow? S52.131B covers the open fracture characters that the S49 physeal codes do not carry.

Need the delayed healing character on an open injury? S52.242J shows how the J character reports delayed healing after an open forearm fracture.

Reporting a late effect rather than a follow-up? S51.801S walks through the sequela character on an upper limb injury.

Coding a typed physeal fracture at the shoulder end? S49.032D covers the Salter-Harris Type III code for the left upper humerus.

Documenting an orthopedic examination finding? Thompson test sets out how the test is performed, interpreted, and recorded in the notes.

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