ICD-10 Code S62.291B: Other fracture of first metacarpal bone

Key takeaways

ICD-10 code S62.291B covers an other fracture of the first metacarpal bone of the right hand, at the initial encounter for an open fracture.

S62.291B is billable and valid for HIPAA-covered claim submission. It took effect on October 1, 2025 under the 2026 edition.

The 7th character B means initial encounter for open fracture. Using A instead is the most common coding error on this code.

The physician must document a wound communicating with the fracture site. Without that language, the coder defaults to S62.291A.

Practice management software like Pabau attaches the correct diagnosis code to every claim, which cuts denials at the 7th character level.

ICD-10 Code S62.291B is the billable code for an other fracture of the first metacarpal bone, right hand. It applies at the initial encounter for an open fracture.

It carries three fixed elements: right-hand laterality, an open fracture, and the initial encounter. Change any one of them and a different code applies.

This reference covers the code’s clinical description, the full 7th character table, and the A-versus-B decision. It also maps the code’s place in the ICD-10-CM hierarchy and its siblings in the S62.29 family.

Then it covers CPT pairing, the four errors that trigger denials, and the documentation a clean claim needs.

ICD-10 Code S62.291B: Definition and billable status

ICD-10 Code S62.291B is a billable, valid-for-submission ICD-10-CM diagnosis code. It describes an other fracture of the first metacarpal bone of the right hand, at the initial encounter for an open fracture.

“Other fracture” here excludes Bennett fractures and Rolando fractures. Those two carry their own codes, S62.21x and S62.22x.

ICD-10-CM codes are updated every year by the Centers for Medicare and Medicaid Services and the National Center for Health Statistics. The CMS coding resources page publishes each release. The 2026 edition, effective October 1, 2025, confirms S62.291B as billable and unchanged from prior editions.

What does S62.291B mean? Breaking down the code

Each segment of S62.291B encodes a specific clinical fact. Coders who understand the structure can quickly verify the code is correct before submission.

• S62 – Fracture of wrist and hand bones (Chapter 19, injuries to the wrist and hand, section S60-S69)
• S62.2 – Fracture of first metacarpal bone (the thumb metacarpal, anatomically distinct from the other four)
• S62.29 – Other fracture of first metacarpal bone (excludes Bennett and Rolando fractures, which carry S62.21x and S62.22x respectively)
• S62.291 – Other fracture of first metacarpal bone, right hand (laterality specified)
• B (7th character) – Initial encounter for open fracture

The first metacarpal is the thumb metacarpal. It is the shortest and most radially positioned of the five metacarpal bones. Fractures here are among the most common hand fractures seen in emergency and orthopedic settings.

The CDC/NCHS official ICD-10-CM web tool confirms the full tabular description and index references for S62.291B.

What the 7th character controls

The 7th character is what separates a clean claim from a denial. The S62.291 family takes seven valid extensions, each with its own clinical meaning. Confusing A with B is the most common error in this family.

The ICD-10-CM Official Guidelines for Coding and Reporting define an initial encounter as any visit where the patient receives active treatment for the fracture.

That includes the emergency room visit, fracture manipulation, and surgical repair. Once the patient moves to routine follow-up, the 7th character shifts to D, G, K, or P depending on how the fracture is healing.

The AAPC code lookup adds crosswalk guidance for the S62.291 family, including modifier context and related procedure pairings.

Rehabilitation teams tracking the same fracture through recovery in a physical therapy EMR code the later encounters rather than the initial one.

S62.291B vs S62.291A: Choosing the right code

The A-vs-B decision is clinical, not administrative. It depends entirely on the documented condition of the overlying skin at the fracture site. Coders cannot make this determination themselves and must rely on physician documentation.

An open fracture does not require visible bone. A puncture wound or laceration that lets the fracture hematoma communicate with the outside qualifies clinically. The treating physician must document the fracture as open.

Without that language, the coder defaults to A. Assigning B without documented open-fracture status is a compliance risk and an audit exposure.

Code hierarchy: Where S62.291B fits in ICD-10-CM

The parent-child hierarchy tells coders where the correct level of specificity sits. It also helps billers spot when a payer is asking for a less-specific parent code in a Local Coverage Determination.

• Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88)
• Section S60-S69: Injuries to the wrist and hand
• Category S62: Fracture of wrist and hand bones
• Subcategory S62.2: Fracture of first metacarpal bone
• S62.29: Other fracture of first metacarpal bone (excludes Bennett S62.21, Rolando S62.22)
• S62.291: Other fracture of first metacarpal bone, right hand
• S62.291B: Initial encounter for open fracture (the fully specific billable code)

Payers require the most specific code available for a clean claim. S62.29 and S62.291 are invalid without a 7th character and will be rejected.

The same hierarchy logic runs through the rest of the injury chapter, including S52.262K. Everywhere in it, 7th character specificity is a billing requirement rather than a documentation preference.

Related codes in the S62.29 family

Coders working on hand fracture claims frequently need to navigate the full S62.291 and S62.292 code sets. The table below maps the full 7th character set for both right and left hand variants. It also lists the named fracture codes in the adjacent subcategories.

Bennett fractures are intra-articular fractures at the base of the first metacarpal, involving the carpometacarpal joint. Rolando fractures are comminuted intra-articular variants.

Both carry their own codes. S62.291B applies only when the fracture meets neither named definition. Later encounters on a metacarpal fracture move to codes such as S62.360G.

Which fractures this code covers

S62.291B maps to a specific subset of first metacarpal fractures. Knowing what is included, and what is excluded, prevents miscoding in both directions.

Included conditions (approximate synonyms):

• Transverse fracture of the first metacarpal shaft, right hand, open, initial encounter
• Oblique fracture of the thumb metacarpal, right, open, initial encounter
• Spiral fracture of the first metacarpal, right hand, open, initial encounter
• Comminuted fracture of the first metacarpal (not meeting Rolando criteria), right hand, open, initial encounter
• Stress fracture or avulsion fracture of the first metacarpal not specified as Bennett or Rolando, right hand, open, initial encounter

Excluded conditions (use a different code):

• Bennett fracture (intra-articular, base of first metacarpal): use S62.21x
• Rolando fracture (comminuted intra-articular, base of first metacarpal): use S62.22x
• Left hand variants: use S62.292B
• Subsequent encounters: use S62.291D (routine healing), G (delayed), K (nonunion), or P (malunion)
• Closed fractures at initial encounter: use S62.291A

Practices running a sports medicine practice see first metacarpal fractures from ball sports and contact injuries. Open wounds are more common there than in simple falls. Where the mechanism involves broken glass, add the external cause code W25.XXXD for the follow-up encounter.

Billing and reimbursement: Pairing the code on a claim

S62.291B is valid for all HIPAA-covered electronic health transactions. That includes professional (CMS-1500) and institutional (UB-04) claim types. Correct use requires pairing the diagnosis code with the appropriate procedure code, correct encounter type, and payer-required modifiers.

Common CPT procedure code pairings: metacarpal fracture care codes used alongside S62.291B sit in the 26600 to 26615 range. The choice depends on the treatment delivered.

Closed manipulation is 26600 or 26605, and open treatment, including internal fixation where performed, is 26615. Verify the pairing against the provider’s documentation and payer bundling rules, since the ICD-10-CM code alone does not fix it.

Practice management software like Pabau lets orthopedic and hand surgery teams attach diagnosis codes to procedures at the point of care.

That shortens the lag between treatment and submission, which is where encounter-type errors creep in. The CMS Physician Fee Schedule tool carries payment and RVU data for the paired CPT codes.

Practices operating under HIPAA must use ICD-10-CM codes in every covered electronic transaction. HIPAA compliance for medical offices treats correct diagnostic coding as part of claim integrity. Submitting a code with no documented clinical support behind it creates audit exposure.

Common coding errors with S62.291B

Four errors account for most denials and audit flags on claims carrying S62.291B. Each one is visible in the claim before it goes out, which makes all four preventable at the coder’s desk.

• Using S62.291A instead of S62.291B without documentation review. Where the notes do not state “open fracture,” coders sometimes default to A. That is wrong whenever the record supports an open fracture. Query the provider rather than guessing.
• Submitting the parent code S62.291 or S62.29 without a 7th character. Neither S62.291 nor S62.29 is a valid billable code. Both are non-specific and will be rejected. Always append the appropriate 7th character to reach a billable, specific code.
• Using S62.291B for a Bennett or Rolando fracture. S62.291B explicitly excludes named fracture types that have their own codes. Where the fracture is intra-articular at the base of the first metacarpal, check the Bennett and Rolando criteria first. Only then default to “other fracture.”
• Applying B to subsequent encounters. Once the patient is in follow-up care after active treatment concludes, the encounter type changes. Continuing to use B on follow-up visits is incorrect and signals a lack of encounter-type awareness to payers during audits.

Practices where coders and clinicians share one documentation workflow see fewer of these errors. Structured note templates that prompt for fracture type and open or closed status are the practical fix.

When you compare claims management platforms, check whether the system flags encounter-type mismatches before submission.

Documentation requirements to support S62.291B

A clean claim using ICD-10 Code S62.291B requires specific clinical documentation elements. These are not optional: without them, the code has no clinical support and creates audit risk.

• Open fracture explicitly documented. The treating physician must document that a wound communicates with the fracture site. Language such as “open fracture,” “compound fracture,” or a clinical description of a wound at the fracture site satisfies this requirement. Absence of skin documentation defaults to closed.
• Right-hand laterality confirmed. The record must specify right hand. Documentation stating “hand fracture” without laterality does not support S62.291B. Use S62.292B for left hand.
• Initial encounter status established. The record must show the patient is receiving active treatment for the fracture. Emergency room notes, operative reports, or first fracture clinic visits typically establish this. Subsequent routine follow-up notes do not.
• Fracture type documented as “other” (not Bennett or Rolando). Where radiographic or operative findings are recorded, there should be no language indicating intra-articular involvement at the base consistent with a Bennett or Rolando pattern.
• Physician attestation and co-signature (where applicable). For teaching hospitals and facilities using resident documentation, the attending physician must co-sign notes used as the basis for diagnosis coding.

Practices using digital clinical forms can build these prompts into the encounter template itself. That removes the back-and-forth between coder and provider that holds claims up. The same documentation discipline applies to soft tissue injuries of the hand such as S61.441D.

How Pabau keeps the 7th character right on hand fracture claims

In most practices the fracture note and the claim live in separate systems. A coder reads the note days later, decides whether the record supports an open fracture, and keys the code by hand.

That delay is where A gets used instead of B, and where a follow-up visit keeps the initial-encounter character it should have dropped.

Practice management software like Pabau closes that loop. The clinician documents laterality and open or closed status in a structured field on the encounter form.

Pabau’s claims management software reads that record directly. The diagnosis code attaches to the procedure at the point of care. The claim is then built from that same record rather than retyped from it.

The outcome is fewer avoidable denials on hand fracture claims and a shorter path from treatment to payment. Every Pabau subscription includes claims, clinical notes, and forms, so a small orthopedic practice runs the same workflow as a multi-site group.

Code hand fractures right the first time

Pabau attaches the correct ICD-10 diagnosis code to every procedure at the point of care and flags encounter-type mismatches before the claim leaves your practice. Fewer denials, faster reimbursement.

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Conclusion

Most denials on first metacarpal fracture claims come down to a single character. Either the wrong 7th character was chosen, or none was appended at all. S62.291B is specific, billable, and valid for the 2026 coding year.

It only performs that way when the note supports open fracture, right-hand laterality, and initial encounter status.

The practical move is to fix this at the point of documentation, not at the point of billing. A note that names laterality and open status leaves the coder nothing to guess at, and the claim goes out clean the first time. Book a demo to see how Pabau supports accurate diagnostic coding.

Continue your research

Coding a hand fracture that failed to heal? S62.606K covers the nonunion encounter, with the same laterality and 7th character rules applied at the far end of the healing timeline.

Following a metacarpal fracture through delayed healing? S62.360G shows how the subsequent-encounter characters work once active treatment has ended.

Documenting an open fracture taken to surgery? The WHO surgical safety checklist records the operative detail that supports the initial-encounter code on the claim.

Want to reduce documentation burden across your practice? Pabau Scribe, our AI scribe, captures structured clinical notes at the point of care. Fracture type, laterality, and encounter type all get recorded consistently.

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