ICD code S89.019S – Salter-Harris Type I physeal fracture of upper end of unspecified

Key takeaways

ICD-10 Code S89.019S is billable for FY 2026 and covers a Salter-Harris Type I physeal fracture of the upper tibia, sequela.

The 7th character S means the visit treats a complication of a healed fracture, never the active fracture itself.

Laterality is unspecified in S89.019S, so use S89.011S for the right tibia and S89.012S for the left when the record says which.

Practice management software like Pabau validates codes before submission, so sequela claims leave with the 7th character and secondary code in place.

ICD-10 Code S89.019S: Overview and billable status

S89.019S is a valid, billable ICD-10-CM diagnosis code for FY 2026, effective October 1, 2025. It covers the sequela encounter for a Salter-Harris Type I physeal fracture of the upper tibia, with laterality unspecified. The CDC/NCHS ICD-10-CM web tool confirms the code is active for the 2026 edition.

S89.019 without a 7th character is not billable, so append the encounter-type character before the claim goes out. The parent code exists only to anchor the hierarchy. Practices running medical claims management can build a validation rule that flags any submission missing a required 7th character.

What does S89.019S mean? Code structure explained

S89.019S breaks into five parts: category, fracture site, Salter-Harris type, laterality, and the 7th character. Each one carries a specific clinical meaning, and misreading a single segment produces the wrong code.

The digit 9 in the laterality position is what marks this code as unspecified. When the record documents right or left, use the laterality-specific sibling code instead. Submitting the unspecified code against a documented side invites a payer query and delays payment.

What is a Salter-Harris Type I physeal fracture?

A Salter-Harris Type I fracture runs entirely through the growth plate, with no extension into the metaphysis or epiphysis. It is the simplest of the five Salter-Harris patterns and generally the most favorable for future growth.

Salter and Harris described the classification in 1963, sorting physeal fractures by where the fracture line sits relative to the physis, metaphysis, and epiphysis. At the proximal tibia, the upper growth plate drives a large share of the bone’s length growth. Damage there risks growth disturbance, especially when the fracture goes unrecognized at the first visit.

• Type I: Fracture through the physis only, with no bony extension. Prognosis for growth is generally good.
• Type II: Fracture through the physis with a metaphyseal fragment. The most common Salter-Harris type overall.
• Type III: Fracture through the physis and into the epiphysis. Intra-articular, so it needs anatomic reduction.
• Type IV: Fracture through metaphysis, physis, and epiphysis. Carries a high risk of growth arrest.
• Type V: Crush injury to the physis. Often diagnosed retrospectively, once growth arrest develops.

The Salter-Harris type is built into the code number, so it decides which ICD-10-CM code applies. A Type II fracture at the same site takes S89.029S, not S89.019S. Assigning the wrong type contradicts the operative or imaging report and creates audit exposure.

What the 7th character means: A, D, and S

The 7th character records what the visit is treating. A covers active fracture treatment, D covers routine healing follow-up, and S covers a complication of a fracture that has already healed. Coders who default to D at every visit after the first miss that distinction, and fracture codes are where it costs the most.

Per the CMS ICD-10 coding guidelines, a sequela encounter usually takes two codes. S89.019S identifies the injury behind the complication, and a second code names the condition being treated.

A patient with post-fracture growth arrest and a varus deformity needs both codes on the claim. Leaving the condition code off is the omission that most often prompts payer review. The panel below turns the whole rule into one question per encounter type.

The upper end of the tibia and its growth plate

The upper end of the tibia means the proximal tibial epiphysis and its growth plate. That is the cartilage zone where the bone lengthens in children and adolescents. Standard orthopedic references put the proximal tibial physis at roughly 55 to 57 percent of total tibial length growth.

Across the S89 codes, upper end always means that proximal physeal region. The distal tibial growth plate sits in the S89.1x series instead, so the two are never interchangeable.

• Proximal tibia (upper end): the growth plate drives a large share of length growth and carries the higher risk of arrest after a physeal fracture.
• Distal tibia (lower end): coded under the S89.1x series, a separate anatomical location.
• Unspecified laterality (digit 9): use only when the record genuinely does not name a side, and update the code once the record is clarified.

Laterality is the field most often left blank at the first visit and never corrected. Recording right or left in the original encounter note removes the need for an unspecified code years later at the sequela visit.

Sibling and parent codes for S89.019S

The sibling codes are where laterality errors get caught. The table below maps the S89.01x family and the parent code above it. The wider ICD-10-CM code archive carries the same 7th character logic across every injury chapter.

The AAPC ICD-10-CM code lookup gives a searchable view of the full S89 category for quick cross-reference during an encounter.

Coding guidelines and documentation requirements for S89.019S

Sequela fracture coding turns on what the note says. The list below follows the ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19, which governs injury sequela coding. Miss one element and a clean claim becomes a denial.

• Confirm the fracture has healed: the sequela designation applies only once the original Salter-Harris Type I fracture is out of its active healing phase.
• Name the sequela condition: the note must say what this encounter treats, such as growth arrest, angular deformity, limb length discrepancy, or chronic pain.
• Sequence the condition first: a specific condition such as post-traumatic varus deformity is usually the principal diagnosis, with S89.019S reported as an additional code.
• Add the resulting condition code: CMS guidance asks for an additional code identifying the nature of the sequela in most cases.
• Match laterality to the record: use S89.011S or S89.012S when the side is documented, and S89.019S only when it is not.
• Query when the note is ambiguous: ongoing healing calls for D, so ask the physician rather than defaulting to S.

Pre-submission validation catches these errors cheaply. A clearinghouse check can flag a missing 7th character or an absent secondary code before the claim reaches the payer.

Practices tightening their denial management usually find sequela claims near the top of the list. Payers examine the link between the sequela code and the condition code closely.

Synonyms that map to S89.019S

Coding references list several clinical terms that map to S89.019S. Recognizing them in a note helps confirm this code rather than a broader sibling.

• Salter-Harris Type I physeal fracture of proximal tibia, sequela (unspecified side)
• Growth plate fracture, upper tibia, Type I, late effect
• Epiphyseal fracture, proximal tibia, Salter-Harris I, sequela
• Physeal fracture upper end tibia (Type I), late effect
• Slipped proximal tibial physis, Type I pattern, sequela

Growth plate fracture is the term that shows up most in lay summaries and patient letters. It does not carry the Salter-Harris type, so confirm the classification from the orthopedic or radiology report before you finalize the code.

How Pabau keeps sequela codes off the denial list

Most practices catch a 7th character error after the remittance comes back. The claim goes out, the payer rejects it, and someone reworks it weeks later. By then the patient’s follow-up has moved on.

Practice management software like Pabau puts the check before the send. Clinical notes, diagnosis codes, and claims live in one record. The code assigned at the visit is the code that reaches the payer, and validation rules flag a submission missing its 7th character.

For an orthopedic or physical therapy practice tracking a Salter-Harris injury across years, that continuity matters. The original encounter note stays attached to the client record, so laterality and fracture type are still there when the sequela visit happens.

Validate ICD-10 codes before the claim goes out

Pabau brings scheduling, clinical notes, and claims into one platform. Practices coding Salter-Harris follow-up visits can check the 7th character and the secondary code before submission. Fewer sequela claims come back.

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Conclusion

The code itself is easy to assign. The claim stands or falls on the note behind it. That note has to say the fracture healed and name what it left behind.

Get laterality into the original encounter record and the sequela visit never needs the unspecified code. Then ask what the visit is treating, and the answer picks the 7th character for you.

Coders who make those two habits routine spend far less time reworking denied musculoskeletal claims. Book a demo to see how Pabau validates ICD-10 codes before a sequela claim leaves your practice.

Continue your research

Coding another fracture sequela? S82.036S applies the same 7th character rules to a nondisplaced transverse patella fracture.

Need the wider S89 category? S89.92XA covers an unspecified injury of the left lower leg at the initial encounter.

Want fewer claims coming back? Clean claims in medical billing sets out what a payer needs to process a claim first time.

Submitting through a clearinghouse? Medical claims clearinghouse guide explains how electronic submission and validation cut denial rates.

New to the billing cycle? What is medical billing? walks through the full path from encounter to payment.

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