ICD code S92.311B – Displaced fracture of first metatarsal bone

Key takeaways

ICD-10 code S92.311B covers a displaced, open fracture of the first metatarsal bone in the right foot at an initial encounter. It is billable and valid through September 30, 2026.

The 7th character B marks an initial encounter for an open fracture. S92.311A is the same fracture with the skin intact.

Displacement and laterality share the sixth character, so a nondisplaced right-foot fracture is S92.314B rather than a variation on S92.311.

Documentation must capture five specifics: right foot, displaced, first metatarsal, open wound, and initial encounter. Missing any one can trigger a denial.

Practice management software like Pabau pairs ICD-10 code lookup with structured note templates. That helps podiatric and orthopedic practices submit clean claims for codes like S92.311B.

ICD-10-CM code hierarchy for S92.311B

Where S92.311B sits in the ICD-10-CM tree affects sequencing decisions and DRG assignment. The table below traces it from chapter down to the 7th character.

Injury codes across the S00-T88 chapter share the same 7th character extension rules. For a displaced first metatarsal fracture, laterality is carried in the sixth character. A 1 means right foot, a 2 means left foot, and a 3 means unspecified foot.

The familiar “9 means unspecified” pattern belongs to the unspecified-bone codes in S92.30, such as S92.309. It does not apply to this bone-specific family. Choosing the wrong laterality character is a common denial trigger on podiatric and orthopedic claims.

Understanding the 7th character extension for S92.311B

The 7th character is not optional on S92.311 codes. Without it, the claim rejects as an invalid code. The character B tells payers this is an initial encounter for an open fracture, where bone communicates with the external environment through a wound.

CMS ICD-10-CM guidelines define “initial encounter” by treatment, not by visit count. It applies for as long as the patient is receiving active treatment for the fracture. A patient transferred to a specialist for surgical management still takes the A or B character, even on a third visit.

S92.311B vs S92.311A: Open vs closed fracture coding

S92.311A and S92.311B describe the same injury at the same stage. Both cover a displaced first metatarsal fracture of the right foot at an initial encounter. Wound status is the only difference between them.

If the notes describe a wound near the fracture site without stating “open fracture” or “bone exposure,” query the provider before assigning S92.311B. Coding an open fracture without documented wound-to-bone communication is a common audit flag.

Related ICD-10 codes for metatarsal fractures

S92.311B sits inside a larger family of metatarsal fracture codes. Coders working with podiatric or orthopedic practices need the whole set to handle laterality switches, nondisplaced variants, and the other metatarsals. AAPC’s ICD-10-CM code lookup is a quick way to confirm a description anywhere in the S92.3 family.

Avoid S92.313B unless laterality genuinely cannot be determined from the documentation. Payers flag unspecified laterality for extra review, and it often prompts a request for records. Knowing which denial codes map to laterality and specificity errors makes those claims easier to scrub before submission.

Clinical documentation requirements for S92.311B

Five documentation elements must all appear in the record to support S92.311B. Each one sets a different character of the code, as the breakdown below shows. Missing any one can produce a payer query or a denial.

• Laterality: Right foot must be stated explicitly. “Right lower extremity” works only if the specific bone is also named. “The foot” does not.
• Fracture type: Displaced. The physician note or the imaging report must describe the fragments as displaced. “Displaced on X-ray” or “fracture with displacement” satisfies this.
• Bone specificity: First metatarsal bone. The first metatarsal is the most medial one, connecting the midfoot to the great toe. The record must name it, not just “metatarsal fracture”.
• Wound type: Open fracture. The note must describe bone-to-external-environment communication, a puncture wound at the fracture site, or the physician’s own statement of an open fracture.
• Encounter type: Initial encounter. Active treatment must be ongoing. Record the treatment given at this visit, such as irrigation, surgical reduction, or wound care.

Injury records read best as standalone clinical documents that an auditor can follow without calling the provider. For an open fracture, include the mechanism of injury, such as a crush, penetrating trauma, or high-energy impact. Payers use it to assess whether the open designation is clinically plausible.

Billing and reimbursement for ICD-10 code S92.311B

S92.311B is valid for HIPAA-covered electronic transactions. Outpatient claims carry it on a CMS-1500 form, and inpatient stays carry it on the UB-04. Reimbursement varies by payer, plan type, and locality, so verify current fee schedule values rather than last year’s.

CPT codes often paired with S92.311B for surgical management include 28485, open treatment of a metatarsal fracture, and 28476, percutaneous skeletal fixation. Treat both as examples, and confirm current AMA CPT descriptors and payer coverage policy before using them. Medicare values for either code sit in the CMS Physician Fee Schedule lookup tool.

Practices submitting these claims electronically benefit from a clearinghouse that checks the ICD-10 and CPT pairing before the claim leaves the office. Practice management software like Pabau runs that check inside its medical claims management module. A code mismatch then surfaces at the front desk instead of in a remittance advice.

Present on admission (POA) indicator

Inpatient hospital claims for S92.311B require a Present on Admission indicator. A traumatic open metatarsal fracture is almost always present on admission, so the indicator is usually “Y”. If the fracture happens during a hospitalization for another condition, the indicator changes to “N”. Outpatient and ED claims do not need one.

Confirm the POA assignment with the attending physician before submission rather than after a query. Coverage is worth checking too, because a plan that excludes surgical open fracture management will deny the claim after the care is delivered.

Where rejections repeat, a clean claim checklist covering POA verification, ICD-10 specificity, and CPT pairing cuts most of the rework. Tracking which S92.311B claims deny, and for what reason, shows whether the problem sits in coding or in documentation.

How Pabau supports accurate ICD-10 diagnostic coding

Podiatric and orthopedic practices handling fracture cases make a specificity decision on every claim. Laterality, displacement, encounter type, and wound classification each change the code that goes out. Pabau keeps that decision next to the clinical note instead of in a separate coding step.

The result is fewer round trips between the chart and the claim. Coders see the documentation that supports each character of the code. Claims then go out electronically through Claim.MD to more than 4,000 US payers.

• Integrated ICD-10 code search: Search and assign codes inside the patient record, so nothing is transcribed by hand.
• Structured clinical note templates: Build encounter-specific templates that prompt for laterality, bone, fracture type, wound status, and the treatment given.
• Claims management: Submit electronically through Claim.MD, with built-in CPT and ICD-10 catalogs that validate a pairing before the claim leaves the practice.
• Denial tracking: Flag denied claims by code and reason code, so a pattern in S92.311B denials points back to the documentation behind it.

Reduce coding errors and submit cleaner claims

Pabau’s built-in ICD-10 code lookup and claims management module helps podiatric and orthopedic practices assign accurate codes and submit electronically through Claim.MD. See how it works for your practice.

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Conclusion

The character that decides this claim is the sixth one, not the seventh. Displacement and laterality travel together in S92.311. A note that reads “metatarsal fracture, right foot” leaves the coder guessing at the part payers scrutinize hardest.

The fix lives in the note rather than in the code book. When the clinician records displacement, bone, wound, and treatment at the point of care, the coder has no judgment call left to make.

Book a demo to see how Pabau prompts for those five fields during the encounter and validates the code pairing before a claim goes out.

Continue your research

Need guidance on medical billing compliance for injury codes? Medical billing compliance covers the frameworks and workflows practices use to stay audit-ready.

Want to understand how claims get submitted electronically? 837 file guide explains the 837P transaction format used for professional claims including fracture treatment.

Handling denials on fracture claims? Denial management in healthcare outlines structured approaches to tracking, appealing, and preventing ICD-10 related claim denials.

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