ICD-10 Code S99.141S: Salter-Harris Type IV physeal fracture of right metatarsal, sequela

Key takeaways

ICD-10 code S99.141S covers a Salter-Harris Type IV physeal fracture of the right metatarsal, coded as a sequela.

The code applies only after the fracture has healed and the visit treats a late effect such as growth arrest or malunion.

S99.141S is billable on CMS-1500 and UB-04 claim forms under the FY2026 edition, effective October 1, 2025.

Parent code S99.141 accepts seven 7th characters, so S sits alongside A, B, D, G, K and P rather than being one of three options.

The sequela condition is coded first and S99.141S second, which is where most of these claims go wrong.

ICD-10 Code S99.141S is the billable diagnosis code for a Salter-Harris Type IV physeal fracture of the right metatarsal, sequela. It applies once the original fracture has healed. The encounter must treat a late effect of that injury, such as growth arrest, angular deformity, or malunion.

According to the CMS ICD-10-CM coding guidance, the FY2026 edition took effect on October 1, 2025, and S99.141S is valid under it. Three things have to line up before a coder can use it: the Salter-Harris type, the laterality, and the 7th character. This reference covers each one, with a related-code table for the calls that sit closest to it.

ICD-10 code S99.141S at a glance

The full official description for ICD-10 Code S99.141S is Salter-Harris Type IV physeal fracture of right metatarsal, sequela. It is a billable code, valid for reimbursement submission. The table below summarizes the key reference facts.

Coders can confirm the current billable status in the CDC/NCHS ICD-10-CM web tool, which mirrors the official tabular list and alphabetic index. Code selection itself stays a human judgment. The safeguard that catches a wrong 7th character is a documentation review before the claim is built, not an edit further down the line.

Code hierarchy and classification

Understanding where S99.141S sits in the ICD-10-CM hierarchy helps coders select the correct level of specificity. Moving from chapter down to the final billable code:

Parent code S99.141 is not billable on its own, so a 7th character always has to be appended before submission. S99 sits inside the S90-S99 section for ankle and foot injuries, alongside physeal fractures of the calcaneus (S99.0) and the toe phalanges (S99.2). Reaching for an S99.0 code on a metatarsal fracture is a clinical accuracy error that payers deny. Every other injury category in the ICD-10-CM code set resolves the same way, from chapter down to a billable code carrying its 7th character.

What is a Salter-Harris Type IV fracture?

The Salter-Harris classification grades physeal (growth plate) fractures by where the fracture line runs relative to the growth plate anatomy. Type IV is one of the more clinically significant grades, because the fracture crosses all three structures.

• Type I: Fracture through the physis (growth plate) only, with no bony involvement
• Type II: Fracture through the physis and into the metaphysis, the most common type
• Type III: Fracture through the physis and into the epiphysis
• Type IV: Fracture crosses the metaphysis, physis, and epiphysis, involving all three zones

Type IV fractures are seen mainly in pediatric and adolescent patients whose growth plates are still open. The fracture line disrupts the epiphysis. If it heals in a displaced position, the risk of growth disturbance, angular deformity, or malunion is meaningful. That is the scenario a sequela encounter records. The fracture heals, and the patient later presents with a complication caused by the growth plate damage.

The metatarsals of the right foot are the anatomical site captured in S99.141S. They are the five long bones connecting the midfoot to the proximal phalanges. A physeal fracture there, classified as Salter-Harris Type IV and documented as right-sided, maps to S99.141 before the 7th character is applied.

The 7th character: what S means and when it applies

The 7th character is what turns parent code S99.141 into a billable code, and S99.141 accepts seven of them. Each character records a distinct point in the course of the injury. Picking the wrong one is the most common compliance risk on physeal fracture claims. The seven characters group into three stages of care.

S (sequela) applies when the original fracture has healed and the visit addresses a direct consequence of it. The sequela condition itself, such as growth disturbance of the right foot, becomes the principal diagnosis and is coded first. S99.141S then follows as a secondary code identifying the causative injury. Clinicians routinely document the late effect and leave the causal injury code out.

When to use S99.141S vs related codes

Telling ICD-10 Code S99.141S apart from its sibling codes is a recurring challenge, particularly around laterality and Salter-Harris type. The table below covers the alternatives a coder meets most often alongside S99.141S.

The AAPC ICD-10-CM code lookup is useful for checking the full sibling set under S99.14 before finalizing a selection.

Documentation requirements for accurate coding

S99.141S is a high-specificity code. Every element of the description has to appear in the physician’s documentation before a coder can apply it. Miss one element and the code either drops to a less specific sibling or draws a denial.

• Salter-Harris type explicitly stated: The physician, not the coder, must document “Type IV” or “Salter-Harris Type 4.” Documentation that says only “physeal fracture” will not support S99.141S and sends the coder to S99.101S instead.
• Laterality confirmed as right: “Right metatarsal” must appear in the record. “Foot fracture” with no side specified forces S99.149S, the unspecified-laterality code.
• Metatarsal identified: Documentation should confirm the fracture involves a metatarsal rather than the calcaneus, talus, or a phalange. An imaging report naming the specific bone is acceptable supporting documentation.
• Sequela encounter confirmed: The clinical note must show the original fracture has healed and the visit is treating a consequence of it. Notes reading “fracture management” or “cast check” describe an active healing encounter, which takes D rather than S.
• Sequela condition documented: The specific late effect needs its own diagnosis in the record. That covers growth arrest, angular deformity, malunion, and limb length discrepancy. It becomes the principal code, with S99.141S second.

Practices managing orthopedic follow-up can capture these elements at intake instead of chasing them at coding. A note template that prompts for type, side, bone, and healing status keeps the record complete months before the sequela visit ever happens.

Billing S99.141S: claim submission and reimbursement

S99.141S is billable on both the CMS-1500 (professional claims) and UB-04 (institutional claims) forms. Because it codes a sequela rather than active fracture treatment, the reimbursement context differs from the initial and subsequent encounter codes. Payers expect S99.141S to appear as a secondary diagnosis supporting a primary sequela condition code, not as a standalone primary diagnosis.

A clearinghouse moves the claim rather than coding it. Practice management software like Pabau builds CMS-1500 claims from the invoice data already on the patient record, submits them through Claim.MD, and tracks each one. Practices that want cleaner claims management get the submission, tracking, and eligibility side automated. Diagnosis selection and sequencing stay a coder’s judgment call.

Sequela denials on S99.141S usually trace to one of two errors. Either the principal sequela condition code is missing, or S99.141S went out while the fracture was still actively healing and S99.141D applied. Both are correctable with an appeal and supporting documentation, though prevention at the point of coding costs far less. Denial management work on fracture claims usually starts with a root-cause audit of 7th character misuse.

Common coding errors to avoid

The four errors below account for the majority of claim rejections and audit flags on S99.141S encounters. Each one is preventable with a documentation review step before code assignment.

• Using S when D is correct: This is the highest-frequency error. If the fracture is still healing and the patient is returning for cast management, pin removal, or routine follow-up, the code is S99.141D. S applies only after healing is complete and the encounter treats a residual effect.
• Omitting the principal sequela condition code: S99.141S should not stand alone as a primary diagnosis in most payer systems. The late effect itself is coded first, whether that is documented angular deformity, growth disturbance, or malunion. S99.141S follows as the secondary code.
• Defaulting to unspecified laterality: S99.149S is acceptable only when documentation genuinely lacks a side. If the imaging report or operative note specifies the right foot, S99.149S is a downgrade that can affect reimbursement and creates an accuracy risk.
• Inferring the Salter-Harris type from imaging alone: Coders cannot assign the classification from an X-ray report without explicit physician documentation. If the physician has not written “Type IV,” query the clinician rather than reading it out of the fracture pattern.

Billing teams working with pediatric orthopedic patients can turn those four errors into a checklist. Confirm type, laterality, bone site, and healed status before the claim is coded, and most of the rework disappears.

Approximate synonyms and clinical context

Medical records use lay and clinical terminology that coders have to map back to the classification. The terms below, appearing in a clinical note or a referral letter, should prompt consideration of S99.141S once the 7th character S is confirmed appropriate.

• Growth plate fracture right metatarsal, late effect
• Type IV epiphyseal fracture right metatarsal, sequela
• Physeal injury right foot, sequela
• Right metatarsal Salter-Harris IV fracture, healed with complication
• Growth arrest right metatarsal following Type IV fracture
• Malunion right metatarsal following physeal fracture

When these terms appear without an explicit Salter-Harris type number, query the physician before assigning S99.141S. A documented “physeal fracture” with no type recorded maps to S99.101S, unspecified physeal fracture of right metatarsal, sequela. S99.191S is a different code and a common mix-up. It covers a physeal fracture the physician did specify, but one that fits no Salter-Harris category.

Standardized intake forms do most of the work here. A note template that requires the Salter-Harris type at the initial encounter is what makes accurate sequela coding possible at a follow-up visit months later.

How these fractures present, and when the sequela shows up

Salter-Harris Type IV metatarsal fractures occur almost exclusively in pediatric and adolescent patients. The growth plates in the metatarsals typically close between ages 16 and 18, so the injury pattern is close to impossible in skeletally mature adults. The usual presentation is a young athlete taking a direct compressive or twisting force through the forefoot.

Because the fracture crosses the epiphysis, surgical reduction is often needed to restore alignment and protect the growth plate. Cases managed conservatively carry a higher risk of malunion. Sequela encounters coded with S99.141S typically arise 6 to 24 months after the original injury. That is when a parent or clinician notices asymmetric foot growth, forefoot deformity, or an altered gait.

That interval is what makes the code hard to assign. The original injury record and the sequela visit are often separated by a year or more, sometimes by a different clinician and a different practice. Longitudinal patient records are what connect the two, so the coder can find the causal injury that S99.141S has to accompany.

How Pabau keeps the fracture record intact from injury to sequela

In most practices, the sequela visit and the original fracture live in different places. The initial encounter note sits in one system and the imaging report in another. By the time the follow-up happens 18 months later, the coder is working from whatever the parent remembers.

Pabau, practice management software for medical and aesthetic practices, keeps that chain on one patient record. The initial encounter note, the Salter-Harris type the physician documented, the imaging, and every follow-up sit on the same file. When the sequela visit comes around, the coder can read the documented type and side without raising a records request.

Structured note templates hold that specificity in place. You can require the Salter-Harris type and the side at the point of documentation. The detail S99.141S depends on is then captured at the initial encounter rather than reconstructed later. Recall rules then bring pediatric fracture patients back on schedule, which is how the sequela encounter gets captured at all.

Invoices built on the coded visit go out through Claim.MD as CMS-1500 claims, with status tracking and eligibility checks on the same screen. Every subscription includes the full platform, so none of it sits behind a higher tier.

Keep the fracture record complete from injury to sequela

Pabau holds the initial encounter note, the imaging, and every follow-up on one patient record. The documented Salter-Harris type and side are there when the sequela visit is coded months later.

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Conclusion

S99.141S rewards documentation discipline more than coding skill. If the physician named the Salter-Harris type, named the right foot, and recorded that the fracture has healed, the code assigns itself. If any of the three is missing, no appeal will supply it after the fact.

So the work sits at the initial encounter, a year or more before anyone needs the code. Build the note template that forces the type and the side, and the sequela visit becomes a two-minute coding decision instead of a physician query. Book a demo to see how Pabau keeps fracture documentation and claim submission on one record.

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