ICD code S92.424S – Nondisplaced phalanx toe fracture

Key takeaways

S92.424S reports a sequela of a nondisplaced fracture of the distal phalanx of the right great toe.

It is billable and specific, and the laterality is right: the left great toe is S92.425S and an unspecified great toe is S92.426S.

The 7th character S applies only to a residual condition left by the healed fracture, never to the fracture while it is still being treated.

Sequence the residual condition first and S92.424S after it, as the sequela guideline requires.

Malunion and nonunion are not sequela codes here: report them as S92.424P and S92.424K.

ICD-10 Code S92.424S: Quick reference

ICD-10 Code S92.424S reports a nondisplaced fracture of the distal phalanx of the right great toe, sequela. Use it when that fracture has healed but left a residual condition, which is coded first.

What does S92.424S mean? Breaking down the code

Each character in S92.424S carries a distinct clinical meaning. Reading them in sequence tells you the injury, the bone, the side and the encounter type.

The great toe, or hallux, has two phalanges. The distal phalanx is the tip of the toe that sits under the nail, and the proximal phalanx joins the foot.

A fracture of the proximal phalanx of the great toe belongs in S92.41-, not S92.42-. The four lesser toes have their own subcategory, and a lesser toe distal phalanx fracture codes to S92.53-.

Within S92.42-, the 6th character carries both displacement and side. Codes 1 to 3 are displaced (right, left, unspecified), and codes 4 to 6 are nondisplaced in the same order.

Understanding the sequela encounter type (7th character S)

The 7th character S marks a sequela: a condition that remains as a direct result of the injury after the fracture itself is healed. Here, that injury is the nondisplaced fracture of the right great toe distal phalanx.

The ICD-10-CM Official Guidelines for Coding and Reporting list seven 7th characters for S92 fracture codes. Picking the wrong one is one of the easier coding errors to prevent.

S92 does not split its subsequent-encounter characters by open or closed fracture. D, G, K, P and S apply to both, and only the initial encounter separates A from B.

The encounter type reflects what the clinician is treating at the visit, not how long ago the fracture happened. A patient still in the healing phase six weeks after the injury gets D.

A patient seen two years later for pain at the tip of the right great toe gets the S character. The note must link that pain to the old fracture.

Residual conditions that S92.424S follows on the claim

S92.424S does not stand alone on the claim. The guidelines put the residual condition first, with S92.424S after it to show where that condition came from. Common residual conditions include the following.

• Chronic post-fracture pain: residual pain at the tip of the great toe after the fracture has clinically healed. The note must link the pain to the prior fracture before S92.424S applies.
• Stiffness of the interphalangeal joint: the great toe has one interphalangeal joint, which can stiffen after the fracture and a period of immobilization. Physical therapy often addresses it.
• Post-traumatic arthritis: joint surface damage can lead to degenerative change. Post-traumatic osteoarthritis of the right ankle and foot is M19.171.
• Nail-bed deformity or dystrophy: the distal phalanx sits under the nail, so a fracture can injure the nail matrix. The resulting nail change is coded as the residual condition.
• Hypersensitivity of the toe tip: post-traumatic sensitivity sometimes follows a crush-type nondisplaced fracture.

Malunion and nonunion are not on that list. The guidelines code complications of fracture healing with the fracture code itself, so a malunion visit is S92.424P and a nonunion visit is S92.424K.

The treating provider establishes the causal link, not the coder. The note should say something like “chronic pain of the right great toe is a sequela of the prior distal phalanx fracture.” When the link is unclear, query the provider rather than infer it.

Follow-up, history or sequela: picking the code for a healed toe fracture

Billers often confuse fracture follow-up, personal history and sequela codes. The wrong choice produces a denial that needs a corrected claim or an appeal, and both cost more than getting it right first. Two questions about the visit settle which code applies.

Aftercare Z codes are not used for injuries. For fracture follow-up, the guidelines assign the injury code with the 7th character D. Complicated healing takes G, K or P instead.

The medical billing compliance point is simple. If the provider has not named a residual condition and tied it to the fracture, S92.424S does not apply.

S92.424S vs. neighboring codes

S92.424S sits among several closely related codes. The table below shows the neighbors most easily confused with it and the clinical differentiator for each.

Displacement comes from the original injury documentation, not the current visit. The guidelines say a fracture not documented as displaced or nondisplaced is coded as displaced. Confirm with the CDC/NCHS ICD-10-CM browser tool and the original imaging before choosing S92.424S.

Excludes and sequencing notes for S92.424S

The CDC/NCHS ICD-10-CM tabular attaches notes at the category and subcategory levels. Sequencing comes from the Official Guidelines instead.

• Excludes2 at S92: fracture of ankle (S82.-), fracture of malleolus (S82.-) and traumatic amputation of ankle and foot (S98.-). An Excludes2 note means the condition is not part of S92, so both codes can be reported when the patient has both.
• Excludes2 at S92.4: physeal fracture of phalanx of toe (S99.2-). If the fracture involved the growth plate, code it from S99.2- instead.
• Sequencing (Official Guidelines, not a tabular note): the sequela guideline puts the residual condition first. S92.424S follows it, and the S goes only on the injury code.
• External cause code: an external cause code with the 7th character S can describe how the original injury happened. National guidelines do not require one unless a state or payer mandate applies.

Documentation requirements for S92.424S

Four documentation elements should be present in the medical record to support S92.424S. A missing one gives the payer a reason to deny the claim.

1. Original fracture history. The record must reference the prior nondisplaced fracture of the right great toe distal phalanx. Cite the original treatment encounter, or have the provider summarize the history in the current note.
2. Provider-stated causal link. The treating provider must document that the current condition results from the prior fracture. Acceptable language includes “chronic pain of the right great toe is a sequela of the prior distal phalanx fracture.”
3. Current residual condition identified. The note must name the residual condition treated at this visit. A note that only mentions the old fracture does not support sequela coding.
4. Side of the injury. The record must show the right great toe. A left great toe injury is S92.425S, and an undocumented side is S92.426S.

Laterality is built into this code: the 6th character 4 means right. If the note and the claim disagree about the side, correct the record or the code before submission rather than after the denial.

Payer requirements and claim submission for sequela toe fracture codes

Medicare and commercial payers generally follow the ICD-10-CM Official Guidelines on sequela coding. Payer-specific policies may still add requirements for the services billed alongside S92.424S.

Before submitting, check the relevant Local Coverage Determination for the procedure billed. Physical therapy, podiatric surgery and orthopedic evaluation each carry their own medical necessity rules.

Common CPT codes on sequela claims include evaluation and management codes (99202-99215), physical medicine codes for rehabilitation and podiatric procedure codes. Medical billing workflows that handle sequela claims benefit from a coder review step before submission.

Common claim denial reasons for S92.424S and how to resolve them

S92.424S denials follow five predictable patterns, and each one has a set correction.

Systematic denial management workflows that track denials against specific ICD-10-CM codes surface these patterns quickly. The medical billing denial codes guide helps teams sort coding, documentation and payer policy issues by CARC reason.

Submitting a clean claim for a sequela encounter needs three things. List the residual condition first, S92.424S second and keep the causal-link language in the provider note.

How Pabau supports clean sequela claims for great toe fractures

Sequela claims usually fail on paperwork rather than on the code itself. The provider note, the diagnosis codes and the claim often sit in different places, so a missing causal-link sentence goes unnoticed until the denial.

Pabau, the practice management platform we build, keeps the clinical note and the billing record on the same patient file. Your coder can read the provider’s wording and confirm the sequence before the claim goes out.

Pabau’s claims management software then submits the claim electronically through its Claim.MD integration and tracks its status. Your team sees which claims came back and can work them from the same record.

Keep sequela claims and notes together

Pabau keeps the provider note and the claim on one patient record. Its claims management software submits claims through Claim.MD and tracks each one, so your team can follow up on denials quickly.

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Conclusion

S92.424S is a narrow code: the right great toe, the distal phalanx, a nondisplaced fracture and a residual problem after healing. Each of those details has a neighboring code, so the note has to support all four.

Most errors come from the 7th character. Use D, G, K or P while the fracture is still being treated, and save S for the condition it leaves behind. When the provider has not named that condition and linked it to the fracture, query before you code.

Book a demo to see how Pabau keeps the provider note and the sequela claim on one record.

Continue your research

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Want to understand the full medical billing cycle behind a sequela claim? Revenue cycle management overview covers the end-to-end process from encounter to payment posting.

Looking for guidance on electronic remittance advice for denied claims? Electronic remittance advice explained shows how to read ERA files and act on CARC denial reasons efficiently.

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