ICD-10 code S49.032D: Salter-Harris Type III physeal fracture, left arm

Key takeaways

S49.032D is the billable ICD-10-CM code for a Salter-Harris Type III physeal fracture of the left proximal humerus, subsequent encounter.

The 7th character D means the patient is past active treatment and the fracture is healing routinely.

S49.0 codes cover the upper end of the humerus, while S49.1 codes cover the lower end near the elbow.

Type III patterns cross both the epiphysis and the growth plate, so joint damage and growth arrest are both risks.

Practice management software like Pabau captures laterality, fracture type, and encounter phase at the point of care.

S49.032D is a billable ICD-10-CM diagnosis code. It describes a Salter-Harris Type III physeal fracture of the upper end of the left humerus, coded for a subsequent encounter with routine healing. Fractures at this site are almost exclusively pediatric injuries, involving the growth plate where active bone development happens.

The code is valid for the current fiscal year under CMS ICD-10-CM guidelines. Pediatric orthopedic practices, emergency departments, and sports medicine practices billing follow-up care for this injury use S49.032D. S49.132D describes the lower end of the humerus, and the two families get swapped often on claims.

For practices managing orthopedic billing, practice management software like Pabau captures the right encounter-specific code at every visit. Claims management software then carries laterality and encounter type through to the claim.

S49.032D code details at a glance

The table below shows every key reference field for S49.032D as documented in the CDC/NCHS ICD-10-CM web tool.

Breaking down ICD-10 code S49.032D character by character

Each character in the ICD-10-CM string carries a specific clinical meaning. Read S49.032D from left to right and the full picture emerges.

Position four is where this code is most often lost. A .0 in that slot places the injury at the upper end of the humerus, near the shoulder. A .1 moves it to the lower end, near the elbow. Everything after that stays the same, which is why the two strings look almost identical on a claim.

Understanding the Salter-Harris classification system

The Salter-Harris system was introduced by Robert Salter and W. Robert Harris in 1963. It classifies physeal (growth plate) fractures in children and adolescents by fracture pattern and anatomical involvement.

Each type carries a different implication for growth disruption and clinical management. ICD-10-CM maps directly onto this classification, so accurate typing drives both documentation and coding.

ICD-10-CM gives Types I to IV their own subcategories, but Type V has no separate entry. A documented crush injury of the physis is reported under S49.09, the code for other physeal fracture of the upper end of the humerus. Coders looking for a dedicated Type V code will not find one.

What does Salter-Harris Type III mean clinically?

A Type III fracture runs vertically through the epiphysis and then horizontally along the physis, entering the joint space. That articular involvement is what separates Type III from the simpler Types I and II. The fracture line crosses the growth plate and the joint surface at the same time.

Clinically, this matters for four reasons.

• Articular involvement raises the risk of post-traumatic osteoarthritis when anatomical reduction is not achieved
• Direct damage to the physis raises the probability of growth arrest or asymmetric growth
• Surgical fixation is required more often than in Type I or Type II injuries
• The usual mechanism is a fall onto an outstretched arm, or forced abduction and external rotation of the shoulder

Type III patterns are uncommon at the proximal humerus, where Types I and II dominate. That rarity is itself a coding risk. If the record only says “growth plate fracture,” a Type III code is not supported, and the unspecified code applies instead.

Orthopedic practices managing these cases often use sports medicine practice software to track imaging, follow-up scheduling, and clinical notes across the recovery period. Physical therapy practices receiving referrals after reduction need the same code for subsequent visits. Physical therapy EMR software with built-in ICD-10 coding supports that handover.

Clinical presentation of a proximal humeral physeal fracture

Proximal humeral physeal injuries account for roughly 2% to 3% of all physeal fractures. They cluster in two groups. Younger children tend to sustain Type I separations, while adolescents near skeletal maturity tend to sustain Type II patterns.

The proximal humeral physis contributes about 80% of the length growth of the humerus. That gives younger patients considerable remodeling potential, which is why many of these fractures are managed without surgery. It also explains why growth arrest at this site has such a visible long-term effect.

At presentation the child guards the arm, resists abduction, and is tender over the proximal humerus. Plain radiographs in two views usually confirm the pattern. MRI is added when the epiphyseal fragment or the articular step-off is hard to characterize on plain films.

Decoding the 7th character: subsequent encounter with routine healing

The 7th character in ICD-10-CM fracture codes is not optional. Per the CMS ICD-10-CM Official Guidelines, S49.032 takes six encounter designators, and each one carries a distinct clinical meaning. Submitting the wrong character is a frequent source of payer denials.

There is no open-fracture 7th character in this subcategory. Physeal fracture codes offer only A for the initial encounter, so an open proximal humeral injury is coded from S42 instead. That series also holds the non-physeal proximal codes, such as S42.212D.

“Subsequent” does not mean a different provider saw the patient. It means active treatment is over and the fracture is now in the healing phase. A physical therapist treating a child for post-fracture rehabilitation uses S49.032D, even at their first visit with that patient.

The encounter character follows the clinical phase, not the provider relationship. It also follows the documented healing status. Use D when the note describes healing as expected or routine, and use G only when the note says healing is delayed. Our guide to S49.102G works through that character.

Why S49.032D gets confused with S49.132D

S49.0 and S49.1 sit one digit apart but describe opposite ends of the same bone. S49.0 codes cover the upper, proximal end at the shoulder. S49.1 codes cover the lower, distal end at the elbow. Both subcategories then subdivide into the same Salter-Harris types and the same laterality digits.

Read the site in the imaging report before you read the type. A note describing the proximal humeral physis or the humeral head points to S49.0. A note describing the distal humeral physis points to S49.1 instead.

One more distinction is worth holding onto. A named fracture of the lateral condyle, the medial epicondyle, or the supracondylar region is not a physeal code at all. Those injuries belong in S42.4, fracture of the lower end of the humerus, alongside codes like S42.409P.

Related ICD-10 codes in the S49.0 subcategory

The S49.0 series covers physeal fractures of the upper end of the humerus. Knowing the full hierarchy helps coders check adjacent codes and confirm that S49.032D is the right pick. Forearm fracture codes such as S52.209K follow the same laterality and encounter-type logic.

Every code above also exists with A, G, K, P, and S in the 7th position. Verify each one against the AAPC ICD-10-CM lookup tool to confirm current-year billable status before you submit. The same laterality and encounter conventions run through the whole injury chapter.

Includes, excludes, and instructional notes

S49.032D inherits instructional notes from the chapter and the block above it. Those notes govern what can be reported alongside the code, and ignoring them is a routine cause of rejections.

• Includes (S40-S49): injuries of the axilla and injuries of the scapular region fall inside this block alongside shoulder and upper arm injuries.
• Excludes2 (S40-S49): burns and corrosions (T20-T32), frostbite (T33-T34), injuries of elbow (S50-S59), and venomous insect bite or sting (T63.4). An Excludes2 note allows both codes together when both conditions are present.
• Excludes2 (S00-T88): birth trauma (P10-P15) and obstetric trauma (O70-O71) are coded separately from traumatic injury.
• Note (S00-T88): add a secondary code from Chapter 20, External causes of morbidity, to identify how the injury happened.
• Use additional code (S00-T88): report Z18.- as well to identify any retained foreign body, where one applies.
• Scope of S49.0: the subcategory covers traumatic physeal fractures of the proximal humerus. Pathological and stress fractures are coded elsewhere.

Coding guidelines and billing considerations for S49.032D

The ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19, govern fracture coding. Six rules do most of the work on this code.

• Laterality is required. Neither S49.03 nor S49.032 is billable on its own. The full seven-character code is mandatory, so use S49.032D for the left arm and S49.031D for the right.
• The encounter character must match the clinical phase. Submit S49.032A only while active treatment is underway. Move to S49.032D once care becomes routine healing management. Using A across the whole episode is a common audit trigger.
• The fracture type must be documented. The treating provider has to state “Salter-Harris Type III” or an equivalent clinical description. Generic “growth plate fracture” wording supports only S49.002D, the unspecified physeal code for this site.
• The anatomical site must be documented. The note or the imaging report has to place the fracture at the upper end of the humerus. Without that, no S49.0 code is supported.
• POA reporting. S49.032D sits on the CMS present-on-admission exempt list, so no POA indicator is needed in inpatient settings. The initial-encounter code S49.032A is not exempt.
• External cause coding. Add a secondary Chapter 20 code identifying the cause of injury. Payers increasingly edit for its absence on trauma claims.

Documentation requirements for S49.032D

For the code to withstand a payer audit, the clinical record needs all six elements below. Missing any one of them is enough to trigger a denial or a downcode.

• Explicit laterality, with “left” appearing in both the diagnosis and the imaging report
• Anatomical site recorded as the upper end of the humerus, confirmed by imaging
• Fracture classification stated as Salter-Harris Type III by the treating or ordering clinician
• Healing status described as routine, using wording such as “healing as expected” or “callus formation on track”
• Encounter context showing follow-up care, such as “routine post-operative check” or “follow-up for physeal injury”
• Provider specialty documented as orthopedic surgery, pediatric orthopedics, sports medicine, or physical therapy

Practices using structured clinical records capture laterality, site, and fracture classification at the point of care. That catches missing detail before the claim goes out. Recording the healing status as a discrete field, rather than free text, keeps the 7th character defensible at the next visit.

Commonly paired CPT procedure codes

S49.032D appears on claims for follow-up management of a healing proximal humeral physeal fracture. The CPT codes below are the ones most often paired with it. Payers check that the procedure and the diagnosis line up on medical necessity, so the CPT has to reflect what happened at the visit.

Two billing points follow from that list. The proximal humeral repair codes 23600, 23605, and 23615 belong to the initial encounter. A claim carrying one of those should almost always show an A, not a D, in the 7th position.

Those fracture care codes also carry a 90-day global period, so routine follow-up inside the window is bundled. Cast supplies stay separately reportable, under HCPCS codes such as A4580. Physical therapy re-evaluations use 97164 rather than a repeat of the initial evaluation code.

The practical result is that S49.032D often appears on a claim with no separately payable evaluation and management code. Coders sometimes read that as an error and change the diagnosis character. The diagnosis should stay as D, because the global period explains the absence of a paid E/M line.

Common coding errors to avoid

Six mistakes account for most denials on S49.032D claims. Each one is preventable with a pre-submission checklist.

• Coding S49.132D by mistake. One digit moves the fracture from the shoulder to the elbow. The descriptors are otherwise near-identical, and lookup tools return both for the same search terms. Read the site in the imaging report first.
• Using S49.032A for follow-up visits. Once the fracture is in the healing phase, A is no longer correct. Carrying the initial-encounter character past the active-treatment window is among the most frequently cited orthopedic coding errors.
• Choosing D when the note says healing is delayed. D means routine healing. Delayed healing takes G, nonunion takes K, and malunion takes P, as in S42.211P. Coders cannot infer healing status from imaging alone, so query the provider.
• Selecting an unspecified or truncated code. S49.03 and S49.032 are not billable. If the note does not state the side, query the provider rather than defaulting to S49.039D.
• Confusing Type III with Type II or IV. Type II extends into the metaphysis rather than the epiphysis, and Type IV crosses all three zones. The pattern description in the imaging report is the source of truth.
• Submitting S49.032S too early. Sequela codes apply only once the fracture has healed and the patient presents with a late effect. A sequela character during active healing will be denied. The same threshold governs sequela codes like S52.119S.

How Pabau captures the detail S49.032D depends on

S49.032D usually fails an audit for documentation reasons, not coding reasons. The side, the Salter-Harris type, the anatomical site, and the healing status all have to be in the record. Those details are typically spread across the imaging report, the operative note, the follow-up note, and the claim.

Pabau keeps them in one place. Custom clinical forms let you record the fracture type, the side, and the healing status as structured fields, so they cannot be left blank. The same values then carry into the next visit, which is where the encounter character usually goes wrong.

Pabau’s claims tools take the diagnosis straight from the note to the claim. Coders stop retyping the string, so a .0 does not become a .1 on the way out. The outcome is fewer denials on follow-up visits, and less rework for your billing team.

Capture fracture coding detail at the point of care

Pabau's structured clinical records and claims tools keep laterality, fracture type, and encounter phase on every orthopedic follow-up note. Your team submits cleaner claims without chasing missing documentation.

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Conclusion

Coding errors on physeal fracture claims rarely come from ignorance of the code itself. They come from thin documentation and a misapplied encounter character. S49.032D has a narrow definition, and that precision is exactly what makes it auditable.

The single check worth building into your workflow is the site. Confirm the fracture sits at the upper end of the humerus, not the lower end, before the claim leaves your practice. That one step prevents the most common error on this code.

Pabau’s claims tools help orthopedic, sports medicine, and physical therapy practices capture laterality, fracture type, and encounter phase on the first pass. To see how that works on your own follow-up visits, book a demo.

Continue your research

Coding the other end of the humerus? S49.102G covers the S49.1 lower-end family and the delayed-healing 7th character.

Working through a fracture nonunion claim? S52.242J walks through the nonunion character on an open shaft fracture.

Coding an injury at the elbow instead? S52.022E covers the olecranon and its open-fracture encounter characters.

Reporting a late effect years later? S52.133S shows how the sequela character works on an upper-limb fracture.

Billing a subsequent open fracture visit? S52.246H explains the open-fracture encounter characters and how each one is chosen.

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