ICD code S59.219G – Salter-Harris Type I physeal fracture, delayed healing

Key takeaways

S59.219G is the billable ICD-10-CM code for a Salter-Harris Type I fracture of the distal radius growth plate, unspecified arm, at a delayed-healing follow-up.

The 7th character G applies only when clinical or radiographic evidence confirms delayed healing. A routine follow-up visit takes D instead.

When the note, exam or imaging names a side, use S59.211G for the right arm or S59.212G for the left. S59.219G is only for a record with no side.

Pabau’s claim validation, part of the practice management platform we build, checks every claim for missing or invalid details before it reaches the payer.

ICD-10 code S59.219G: Quick reference

ICD-10 code S59.219G is the billable ICD-10-CM code for a Salter-Harris Type I physeal fracture of the lower end of the radius, unspecified arm. It reports a subsequent encounter for that fracture with delayed healing.

Use it at a follow-up visit where imaging or the physician confirms slow healing, and the record names no side. The table sets out the billing facts to confirm before the claim goes out.

What S59.219G covers: Full code descriptor and scope

S59.219G covers one clinical situation. The patient is back for a follow-up visit after a Salter-Harris Type I fracture through the growth plate at the distal radius. Healing has fallen behind the expected timeline, and the treating physician has not documented which arm is affected.

Each of the four components has a coding alternative if the documentation changes:

• Salter-Harris Type I: Fracture through the physis only, with no involvement of the epiphysis or metaphysis. The epiphysis separates from the metaphysis along the growth plate. No bone fragment breaks away.
• Lower end of radius: The distal radial physis, located just proximal to the epiphysis. This is the most common site of physeal injury in children and adolescents.
• Unspecified arm: The physician’s documentation does not identify right or left. It is a valid choice only when the record genuinely lacks laterality. It is never a default for a note nobody checked.
• Subsequent encounter with delayed healing: The patient has returned for follow-up after the acute event. Clinical or radiographic evidence shows healing is slower than expected for this fracture type.

Reclassify the fracture type, identify the side, or record a change in healing status, and a different code applies. Every other pediatric distal radius fracture, and every other encounter phase, has its own code.

Understanding the 7th character ‘G’: Subsequent encounter with delayed healing

ICD-10-CM assigns six 7th characters to the S59.21_ fracture group. Picking the wrong one is a common cause of denials on this code family. Repeated across many claims, it becomes a pattern auditors look for.

The G-vs-D choice deserves the most care on this code family. “D” means healing is progressing as expected, while “G” means clinical or imaging findings show it is not. Ongoing symptoms alone do not justify G. The treating physician must document delayed healing, ideally citing X-ray findings or a defined timeline deficit.

The G-vs-S choice catches out experienced coders too. “S” (sequela) applies once the fracture has resolved and a residual condition is the reason for the visit. A physeal bar or angular deformity is typical. While the fracture itself is still the active clinical problem, G or D applies.

Put together, the code comes from two answers in the note: what kind of visit this is, and which side was injured. The chart shows how those answers combine.

Salter-Harris Type I physeal fractures: Clinical background for coders

The Salter-Harris type decides which ICD-10-CM subcategory a growth plate injury codes to, so coders need to know what separates the five types. This matters most where sports medicine and pediatric orthopedic cases share one billing workflow.

• Type I: Fracture plane runs through the physis only. The epiphysis separates from the metaphysis with no bony fragment. It is often subtle on X-ray, where the physis may look only slightly widened. Codes to S59.21_.
• Type II: Fracture through the physis with a triangular metaphyseal fragment on the tension side. Most common type. Codes to S59.22_.
• Type III: Fracture through the physis and epiphysis, extending to the joint surface. Codes to S59.23_.
• Type IV: Fracture crosses the metaphysis, physis, and epiphysis. Codes to S59.24_.
• Type V: Crush injury to the physis. Rare and often missed acutely. There is no Type V subcategory, so it codes to S59.29_, other physeal fracture of lower end of radius.

Type I fractures are most common at the distal radius in children aged 10 to 14, typically after a fall on an outstretched hand. At this age the physis is weaker than the surrounding ligaments. So an injury that would be a sprain in an adult often presents as a physeal separation.

For physical therapy follow-up and rehabilitation visits, confirm the original fracture type from the acute-care record before assigning any S59.21_ encounter code.

S59.219G vs adjacent codes: How to choose the right code

Five neighbors of ICD-10 code S59.219G differ from it only on laterality or encounter phase. Check the comparison before filing to confirm you have the most specific code. For visits during active treatment, the initial-encounter code S59.219A applies instead.

S52 codes, such as S52.509_, cover fractures of the radius that do not involve the physis. When the record documents a Salter-Harris Type I fracture of the distal radius, use the S59.21_ group instead.

An S52 code on a confirmed physeal fracture misrepresents the injury. It can also understate the management involved, particularly growth plate preservation.

Excludes notes and code instructions for S59.219G

S59.219G inherits instructional notes from its parent categories. Review these before coding to avoid claim rejection on incompatibility grounds.

At the S59 category level:

• Excludes2: Other and unspecified injuries of wrist, hand and finger(s) (S69.-). An injury documented at the wrist, hand or fingers codes from S69. The distal radius physis sits in the forearm, so S59 is correct for physeal fractures at this site.
• Use additional code for any associated open wound.

At the S59.21 subcategory level:

• No further Excludes notes apply at S59.21 beyond those inherited from S59.
• ICD-10-CM guidelines require a 7th character for all codes in this subcategory. A code submitted without a valid 7th character is structurally invalid and will reject at the payer’s edit stage before clinical review.

Also confirm whether payer or institutional policy requires an external cause code from V00-Y99 to record the mechanism of injury.

Documentation requirements to support S59.219G

Every element of S59.219G must be traceable to a specific statement or finding in the clinical record. The medical billing compliance risk on this code is concentrated in two areas: The delayed-healing designation and the unspecified laterality.

• Fracture type (Salter-Harris I): The physician’s note must state the Salter-Harris classification, or the radiology report must describe a pure physeal separation without bony fragment. “Growth plate fracture” with no type supports only S59.20_, the unspecified physeal fracture subcategory.
• Location (lower end of radius): The note must reference the distal radius, distal radial physis, or lower end of the radius. “Wrist fracture” without specifying the bone and site does not support S59.21_.
• Laterality note: If the chief complaint, physical exam or imaging report names right or left, use the laterality-specific code, S59.211G or S59.212G. Using S59.219G when the side is documented is a specificity deficiency that payers may flag on audit.
• Evidence of delayed healing: The physician must document that healing is slower than expected. Alternatively, the radiology report must describe delayed callus formation, a persistent fracture line, or a comparable finding. A patient reporting continued pain without radiographic evidence is not sufficient to support “G” over “D.”
• Encounter type (subsequent, not initial): The note must reflect a follow-up visit after the acute injury event. Active treatment encounters use 7th character A, not G.

Payer requirements and prior authorization considerations

As a diagnosis code, S59.219G does not trigger prior authorization on its own. The procedures billed alongside it may. For delayed-healing fracture management, payers often ask for medical necessity documentation before approving more imaging, hardware removal or surgery.

Key payer considerations for delayed-healing fracture claims:

• Medicare has no national coverage determination (NCD) for physeal fracture follow-up. Coverage follows the local coverage determination (LCD) of the MAC jurisdiction. Verify the current LCD for fracture management in your region against the CMS ICD-10 codes page.
• Medicaid managed care plans vary by state. Some require a primary care referral for orthopedic follow-up beyond a defined visit count.
• Commercial payers generally accept S59.219G when the record supports all five documentation elements above. Many also want the radiology report attached electronically when “delayed healing” qualifies the encounter.

Common claim denial reasons for S59.219G and how to avoid them

Denials on S59.219G tend to follow a small set of patterns, and each has a prevention step for the pre-submission workflow. For tracking and appealing ICD-10 denials more broadly, see the denial management guide. The denial codes reference defines each CARC and RARC code.

How claims software catches S59.219G errors before submission

Each denial pattern above starts with a detail nobody checked before the claim went out. Catching those by hand means a coder rereads every follow-up note against the claim form.

Pabau keeps the follow-up note and the claim in one patient record. Its claims software with validation checks every claim for missing or invalid details before it leaves, such as a code sent without its 7th character.

Claims then travel through the Claim.MD clearinghouse, our US partner, to thousands of payers. Eligibility checks run before the follow-up visit, so a coverage or authorization problem shows up before the claim exists. When a payer rejects a claim, Pabau shows the reason so the team can correct and resubmit it.

Catch fracture coding errors before the payer does

Pabau’s claim validation checks each claim for missing or invalid details before it leaves, and Claim.MD carries it to thousands of US payers. Rejections come back with their reason, ready to correct.

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Conclusion

S59.219G holds up on audit only when the note supports all three qualifiers: the Type I fracture, the missing side and the delayed healing. Protect the G first. A radiology line about slow callus formation or a persisting fracture line is what separates it from D.

Then reread the note for a side before you file. If the chief complaint, exam or imaging names one, the claim needs S59.211G or S59.212G. Book a demo to see how Pabau keeps the follow-up note and the claim side by side, so that check takes seconds.

Continue your research

Coding the same delayed-healing stage on the ulna? ICD-10 code S59.032G covers a Salter-Harris Type III physeal fracture of the lower end of the left ulna with delayed healing.

Was the fracture reclassified as Type II? ICD-10 code S59.221S explains the sequela code for a Salter-Harris Type II fracture of the right distal radius.

Did the fracture line extend into the epiphysis? ICD-10 code S59.231S covers the sequela of a Salter-Harris Type III fracture of the right distal radius.

Was the physeal separation pinned percutaneously? CPT code 25606 covers percutaneous skeletal fixation of a distal radius fracture or epiphyseal separation.

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