ICD code V43.42XS – Person boarding or alighting a car injured in collision, sequela

Key takeaways

V43.42XS reports a person boarding or alighting a car who was hurt in a collision with another car, at a sequela encounter.

Pick-up trucks, vans and sport utility vehicles have their own V43.4 codes, so confirm the other vehicle before you assign V43.42XS.

Seventh character S fits a visit for a late effect of the injury, while A covers active treatment and D covers routine healing care.

List the sequela condition first and the injury code with S next, then V43.42XS, which can never be the first-listed diagnosis.

No national rule requires external cause codes, so report V43.42XS when your payer or state mandates it, and voluntarily otherwise.

ICD-10 code V43.42XS covers the late effects of a car boarding injury

ICD-10 code V43.42XS is a billable ICD-10-CM external cause code. Its official descriptor is Person boarding or alighting a car injured in collision with other type car, sequela. Use it when a patient was hurt getting into or out of a car during a crash with another car. Today’s visit then treats a late effect of that injury.

“Other type car” means a passenger car that isn’t a sport utility vehicle, pick-up truck or van. Those vehicles have their own codes. V43.42XS never stands first on a claim, because it explains how the injury happened rather than what is being treated. You can check the current descriptor in the CDC/NCHS ICD-10-CM web tool.

Where V43.42XS sits in the V43 hierarchy

Each level of the code narrows the event, from any external cause down to one occupant position and one vehicle type. Reading the chain top to bottom is the quickest way to confirm you have the right endpoint.

The fourth character tracks where the patient was. The .4 subcategory covers someone in the act of getting into or out of the car. A driver in a traffic accident falls under V43.5-, and a passenger in a traffic accident falls under V43.6-.

The fifth character then names the other vehicle. That is why V43.42 only fits a collision with another passenger car. If you’re newer to how these codes reach a payer, our guide to how medical billing works covers the basics.

The seventh character decides between A, D and S

The seventh character tells the payer what stage of care the visit belongs to. It follows the type of care, not the time since the crash. The external cause code takes the same seventh character as the injury code it accompanies.

Section I.C.19.a of the ICD-10-CM Official Guidelines sets these definitions, and Section I.B.10 covers sequela. A patient back for a cast check is a D patient. That same patient returning six months later with joint stiffness from the healed fracture is an S patient.

The panel below pairs each seventh character with the claim order a sequela visit needs.

When V43.42XS is the right choice

V43.42XS fits when three conditions hold. The injury happened while the patient was boarding or alighting a car hit by another car. Active care for that injury has ended. And today’s visit is for a condition the injury caused.

• The original injury has healed: There is no more fracture care, open wound care or acute treatment for the collision injury itself.
• A residual condition is present: Chronic pain, nerve damage, a scar or post-traumatic arthritis is being treated now.
• The link is documented: The note ties the current condition to the specific collision.
• It isn’t routine healing care: A follow-up while the injury is still healing takes D, not S.

Sequela vs. subsequent encounter: telling S from D

Ask what the visit is treating. Routine care for the injury while it heals takes D. Once the injury has healed and you’re treating what it left behind, S is correct.

How to sequence a V43.42XS claim

A sequela claim reverses the usual injury pattern, because the condition being treated goes first. Section I.B.10 of the Official Guidelines sets that order. Section I.C.20.i covers external cause codes for sequela.

1. The sequela condition first: List the late effect being treated, such as M54.2 cervicalgia, G89.21 chronic pain due to trauma, or L90.5 scar conditions.
2. The injury code with S next: Add the code for the original injury with seventh character S, so the payer sees what caused the condition.
3. V43.42XS after them: The external cause code explains the mechanism. Section I.C.20.a.6 states it can never be the first-listed diagnosis.
4. Leave off Y92 and Y93: A Y92 place-of-occurrence code is reported once, at the initial encounter (I.C.20.b). Y93 activity codes don’t apply to sequela (I.C.20.c).

Companion codes at a glance

V43.42XS adds context to the clinical codes on the claim but never replaces them. Here is how each code type behaves at a sequela visit.

What the V43 category covers, and what it leaves out

The tabular list sets the scope of V43 and points other collision types to their own categories. These are the points that matter when you assign V43.42XS.

• Scope of V43: A car occupant injured in collision with a car, pick-up truck or van.
• Traffic status: V43.0-V43.3 cover nontraffic accidents, V43.4 covers boarding or alighting, and V43.5-V43.9 cover traffic accidents.
• No category-level Excludes1: V43 carries no Excludes1 note of its own.
• Other collision types: V44-V49 are separate categories, such as V44 for heavy transport vehicle or bus and V45 for a railway train.
• Block notes: Check the notes at the start of block V40-V49 in the tabular list, which apply to every category inside it.

Adjacent codes that get confused with V43.42XS

Most mix-ups come from the wrong seventh character, the wrong occupant position or the wrong vehicle type. The table shows when each neighbor applies. When in doubt, check the descriptor in the AAPC ICD-10-CM lookup.

Why V43.42XS claims get denied

Most V43.42XS rejections trace back to a handful of avoidable coding choices. Here are the ones to watch for.

• Seventh character D used instead of S: Once the injury has healed and only the late effect remains, D misdescribes the visit.
• External cause code listed first: Section I.C.20.a.6 bars an external cause code from the first-listed position, so payers reject claims that lead with V43.42XS.
• Sequela condition missing: Without a clinical code for the residual condition, the payer has no payable diagnosis.
• Y92 or Y93 added at a sequela visit: Y92 belongs to the initial encounter (I.C.20.b), and Y93 doesn’t apply to sequela (I.C.20.c).
• Wrong occupant position: A driver takes V43.52XS and a seated passenger takes V43.62XS, not the boarding or alighting code.
• Wrong vehicle type: A collision with a pick-up truck is V43.43XS, and one with a van is V43.44XS.

A steady denial management process catches these patterns before they repeat. When a claim does come back, the remittance names the reason with an adjustment code. Our guide to denial reason codes explains how to read them.

A before-you-submit checklist

Run through these five checks before a V43.42XS claim goes out.

• The note confirms the original injury has healed and names the residual condition.
• The sequela condition is listed first, followed by the injury code with S.
• V43.42XS sits after the clinical codes, never in the first position.
• The note records that the patient was boarding or alighting, and that the other vehicle was a car.
• No Y92 or Y93 code is attached to the sequela visit.

What payers expect in the documentation

Sequela claims from a motor vehicle crash need more than a diagnosis list. Medicare, Medicaid and auto-liability insurers all want the record to show how the crash led to today’s condition.

• The original event: Records should describe the collision, the patient’s position and how the injury happened. Earlier encounter notes usually carry this.
• Healing of the acute injury: A note confirming the original injury has healed supports the move from D to S.
• The residual condition, specifically: “Patient still has pain from accident” isn’t enough. Describe the condition clearly and code it as the first-listed diagnosis.
• Auto-liability payers: Many ask for a narrative report linking the condition to the accident, especially for chronic pain. A clinical note alone may not meet their standard.
• Medicare as secondary payer: When an auto insurer may be primary, Medicare Secondary Payer rules apply. The external cause code helps show the claim relates to an accident.

With auto-liability cases, run insurance eligibility verification upfront to confirm which payer is primary. Then you’ll know what documentation each one expects.

Submitting a clean claim means the documentation, sequencing and payer rules are all met before the first submission. Setting up electronic remittance advice also helps, because payers use it to explain each denial.

Current-year validity and code updates

V43.42XS is a valid, billable code in the current ICD-10-CM code set. The FY2027 release took effect on October 1, 2026, so confirm the code in the CDC/NCHS web tool for that release.

ICD-10-CM updates run on the federal fiscal year, with new, revised and deleted codes taking effect each October 1. Check the CMS ICD-10-CM codes page each summer to see what is changing before the new year starts.

How claims management software supports V43.42XS claims

In many practices, a biller retypes diagnosis codes from the clinical note into a claim form. Every retyped code is a chance to drop the external cause code or swap a seventh character.

Pabau, the practice management and billing platform we build, pre-fills the claim from the patient record. Coders pick codes from built-in ICD-10-CM and CPT lookup libraries. Pabau checks that required claim fields are complete, then submits through the Claim.MD clearinghouse. Its claims tools for practices also run eligibility checks, post electronic remittances and track each claim.

The coder still decides the seventh character and the code order. What changes is the busywork around those decisions, so fewer claims bounce back for missing data.

Send complete claims the first time

Pabau pre-fills claims from the patient record, checks required fields and submits through Claim.MD. Your team spends less time fixing claims that bounced for missing data.

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Conclusion

With V43.42XS, the expensive mistakes happen before the claim leaves the building. Confirm the patient was boarding or alighting, and that the other vehicle was a car. Then ask whether today’s visit treats a late effect. If it does, S is right and the sequela condition leads the claim.

Build those checks into intake and coding, and sequela claims stop coming back for avoidable reasons. They’re one small piece of revenue cycle management, but they recur for months after a crash.

Book a demo to see how Pabau pre-fills and tracks your injury claims from the patient record.

Continue your research

Need to read a denial after a V43.42XS rejection? Denial codes in medical billing explains CARC and RARC reason codes for faster claim resolution.

Want a closer look at the clearinghouse step? Medical claims clearinghouse explains how claims travel from your practice to the payer.

Billing injury claims and checking your compliance? Medical billing compliance covers the documentation and regulatory basics.

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