ICD code S89.142S – Salter-Harris type IV left distal tibia sequela

Key takeaways

ICD-10 Code S89.142S is a billable code for sequela encounters after a Salter-Harris Type IV fracture of the left distal tibial growth plate.

The 7th character S applies only when the visit treats an active late effect, such as growth arrest, angular deformity or limb-length discrepancy. Routine follow-up of a healing fracture takes D instead.

S89.142S is sequenced second, after the code for the late effect being treated, per ICD-10-CM Official Guidelines Section I.B.10.

Pabau’s claims management software and Claim.MD clearinghouse integration support accurate sequela claim submission and real-time denial tracking for orthopedic practices.

ICD-10 Code S89.142S: Code details and billable status

ICD-10 Code S89.142S is a valid, billable code for a sequela encounter after a Salter-Harris Type IV fracture of the left distal tibia.

It appears unchanged in the CMS code set for fiscal year 2027, which took effect on October 1, 2026. The code sits in category S89 (other and unspecified injuries of lower leg), within the injury chapter (S00-T88).

Code descriptor breakdown for S89.142S

Every character in S89.142S carries a distinct clinical meaning. Misreading even one segment, particularly the laterality digit or the 7th character, produces the wrong code and a denied claim.

Clinical notes and code references write the code with its decimal point, as S89.142S. Electronic 837 claims drop the decimal and transmit S89142S, so let your claims software handle that conversion rather than keying it by hand.

What is a Salter-Harris Type IV fracture of the distal tibia?

A Salter-Harris Type IV fracture is a growth plate (physeal) fracture whose line crosses the epiphysis, the physis and the metaphysis in a single injury. The distal tibia is a common site for physeal fractures in children.

Type IV is more serious than Types I-III because the fracture disrupts the germinal cell layer of the physis. That disruption carries a meaningful risk of growth arrest, angular deformity or leg-length discrepancy. Those are the sequelae that bring patients back for care under S89.142S.

Salter-Harris classification at a glance

Patients are typically skeletally immature at the time of the original injury. The sequela visit may come months or years later. By then a late effect, such as physeal bar formation or a measurable limb-length discrepancy, needs active treatment.

What the sequela (S) 7th character means

The 7th character S designates a sequela encounter under ICD-10-CM Official Guidelines Section I.C.19.a. The current visit treats a direct late effect of the original Salter-Harris Type IV fracture of the left distal tibia, rather than the fracture itself.

Confusing S with D is a common coding error on this code family. Here is the practical distinction:

• A (initial encounter): The patient receives active treatment for the fracture itself. This includes the first visit, any surgical intervention, and the period of definitive care.
• D (subsequent encounter): The fracture is still healing. The patient returns for cast checks, hardware monitoring, wound care, or other routine follow-up while the bone is still consolidating.
• S (sequela): The fracture is resolved, but a direct late effect persists, such as growth plate arrest, angular deformity, or leg-length discrepancy. The current encounter treats that complication specifically.

Sequencing rule: Sequela condition code comes first

Under Section I.B.10 of the ICD-10-CM Official Guidelines, the code for the nature of the sequela is sequenced first. That is the late effect condition being treated, and S89.142S follows it as the underlying cause. Payers commonly deny a claim that lists S89.142S as the primary diagnosis without a companion sequela condition code. The decision path below shows which 7th character an encounter takes and how a sequela claim lines up.

Common sequela condition codes paired with S89.142S include:

• M89.8X6 (other specified disorders of bone, lower leg), for physeal bar or growth arrest
• M21.862 (other specified acquired deformities of left lower leg), for angular deformity secondary to growth disturbance
• M21.762 (unequal limb length (acquired), left tibia), for leg-length discrepancy

S89.142A vs S89.142S: Choosing the correct encounter code

S89.142A and S89.142S describe the same fracture anatomy but very different clinical situations. Selecting the wrong encounter type is a common denial trigger for this code family.

Documentation requirements for S89.142S

Payers audit sequela codes closely because the S character asserts a causal link to a prior injury on a specific side. The medical record must show all four elements below before S89.142S goes out on a claim. Together they make it a clean claim, and each missing element is a potential denial trigger.

• Confirmed prior fracture: imaging reports, operative notes, or prior encounter records establishing a Salter-Harris Type IV fracture of the left distal tibia. The original documentation can be from another facility, as long as it is referenced or scanned into the current record.
• Active treatment of a named late effect: the current note must name the specific complication being treated. Examples are “physeal bar with resulting 2 cm limb-length discrepancy” or “angular valgus deformity secondary to growth plate arrest.” Vague language such as “post-fracture monitoring” describes a subsequent (D) encounter, not a sequela.
• Laterality confirmed as left: the note and imaging must clearly document the left side. A mismatch between the diagnosis code and the operative or imaging site is a common claim rejection trigger.
• Skeletal immaturity at the time of the original injury: note that the patient was skeletally immature when the fracture occurred. For adult patients presenting with sequelae of childhood injuries, the original imaging or prior records should confirm this.

Practices managing medical billing compliance for orthopedic sequela cases benefit from structured documentation templates. These prompt coders and clinicians to capture each element at the point of care, and missing even one weakens the claim’s audit trail.

Commonly paired CPT codes and procedures

Sequela visits for S89.142S typically involve corrective or evaluative procedures rather than routine fracture management. Medical billing workflows for these encounters pair the diagnosis with a procedure code that matches the specific intervention. Verify payer-specific pairing rules before billing, since not every payer accepts every pairing for every patient population.

27477 describes the proximal tibia and fibula only. It fits when the surgeon slows growth in the longer, uninjured leg, not an arrest at the injured distal physis. For a procedure on the left distal tibia itself, confirm the exact CPT code against the operative note and the payer’s pairing rules.

Payer requirements and claim submission for S89.142S

S89.142S is most common in pediatric populations, so Medicaid is frequently the primary payer. Commercial payers covering dependent children typically require pre-authorization for corrective surgical procedures such as epiphysiodesis or tibial osteotomy. Medicare coverage applies mainly when an adult presents with late effects of a childhood fracture, a less common but valid scenario.

Key payer considerations for orthopedic claims management:

• Pre-authorization: many commercial payers require prior authorization for CPT codes 27477 and 27705 when billed with a sequela diagnosis. Confirm requirements before scheduling surgery.
• Medical necessity documentation: payers expect objective findings supporting the need for active intervention. Examples include a measured limb-length discrepancy greater than 2 cm, radiographic evidence of physeal bar, or quantified angular deformity.
• Sequencing on the claim form: the sequela condition code goes on line A of Box 21, with S89.142S on the line below it. For limb-length discrepancy, line A would carry M21.762.
• S89.142S cannot be billed alone: payers commonly deny a claim that lists this code as the sole diagnosis in Box 21. The sequela condition code is not optional.

Common claim denial reasons for ICD-10 Code S89.142S

Sequela codes draw extra payer scrutiny because they rely on a causal chain that must be explicit in the record. Denial management in healthcare for physeal fracture sequelae centers on six root causes:

• No companion sequela condition code: S89.142S submitted as the primary or sole diagnosis. Per ICD-10-CM guidelines, the nature of the sequela is the first-listed code. This is a frequent denial trigger.
• Wrong 7th character (S vs D): the encounter documents fracture follow-up while the bone is still healing. That is a subsequent (D) encounter. Use S only when the fracture is resolved and a distinct late effect is being actively treated.
• Laterality mismatch: the claim codes the left side (S89.142S) but the operative or imaging report documents the right. Payers cross-reference laterality between the ICD-10 code and procedure site documentation.
• Missing original fracture documentation: no prior record establishing the Salter-Harris Type IV fracture of the left distal tibia. Without proof of the original injury, payers cannot confirm the causal link required for a sequela code.
• Unspecified-side code used when laterality is known: submitting S89.149S (unspecified) when the patient record clearly documents the left side. Payers increasingly reject unspecified codes when the record supports specificity. The CMS ICD-10-CM code files list separate left, right and unspecified codes for this fracture.
• Missing imaging or operative support: the claim lacks an attached operative report or imaging documentation confirming the sequela condition being treated. Prior authorization approvals do not substitute for the clinical documentation itself.

Practices that track denial reason codes for sequela claims can spot systematic errors faster. If CO-11 (diagnosis inconsistent with procedure) recurs on these claims, the sequencing or companion code pairing is the likely cause.

How Pabau catches sequela claim errors before submission

Many practices only learn that a sequela claim lacked its companion code when the denial comes back. A coder then pulls the note, adds the late effect code, reorders Box 21 and resubmits, often weeks after the visit.

Pabau, the practice management and billing platform we build, checks the diagnosis pair before the claim leaves. Its Claim.MD clearinghouse integration validates code pairs and sequencing at submission and runs real-time eligibility verification. Electronic remittance advice (ERA) processing returns denial reason codes quickly when a sequela pair is rejected.

The result is fewer sequela claims returned for a missing companion code, and a clear reason code to act on when one does come back.

Manage orthopedic sequela claims without the rework

Pabau’s claims management tools and Claim.MD integration help orthopedic and pediatric practices submit accurate sequela claims and track denial reasons. Claims go out with complete documentation the first time.

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Conclusion

S89.142S is simple to define and easy to misbill. The fix sits upstream of the claim, in a note that names the late effect, confirms the left side and references the original fracture.

If your team bills sequela codes often, build the companion code into charge capture instead of catching it at denial. The trade-off is a little more structure at the point of care in exchange for fewer resubmissions. Book a demo to see how Pabau validates sequela code pairs before the claim goes out.

Continue your research

Need to understand how claims flow from code to clearinghouse? How medical claims clearinghouses work explains the end-to-end submission path and where sequela claims are most often flagged.

Tracking denial patterns across your orthopedic caseload? The Claim.MD clearinghouse guide covers how ERA processing surfaces denial reason codes before they age into write-offs.

Want a reference for fracture billing paperwork? The superbill guide outlines what must appear on the superbill to support a diagnosis.

Coding a right-side physeal fracture sequela? S89.121S covers the sequela of a Salter-Harris Type II fracture of the lower end of the right tibia.

Still treating a left distal tibia fracture that is slow to heal? S89.132G covers the delayed-healing follow-up for a Salter-Harris Type III fracture on that side.

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