{"id":183548,"date":"2026-08-18T09:01:57","date_gmt":"2026-08-18T09:01:57","guid":{"rendered":"https:\/\/pabau.com\/?p=183548"},"modified":"2026-08-18T10:59:49","modified_gmt":"2026-08-18T10:59:49","slug":"icd-10-code-s49109p","status":"publish","type":"post","link":"https:\/\/pabau.com\/fr\/diagnostic-codes\/icd-10-code-s49109p\/","title":{"rendered":"ICD-10 code S49.109P: Distal humerus growth plate malunion"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"ICD-10 code S49.109P: Unspecified physeal fracture of lower end of humerus, unspecified arm, subsequent encounter for fracture with malunion\",\"description\":\"ICD-10 code S49.109P reports a growth plate fracture of the lower end of the humerus that has united in a poor position. Covers the 7th character rules, the Salter-Harris codes, sibling codes and documentation requirements.\",\"url\":\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s49109p\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-07-25\",\"dateModified\":\"2026-08-18\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>ICD-10 code S49.109P covers a growth plate fracture at the lower end of the humerus that healed in a poor position<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>The 7th character P means malunion. Sequela is a different character, S, and a different claim<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>S49.1 holds the lower end of the humerus, S49.0 holds the upper end, and no S49.2 exists in ICD-10-CM<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Move to S49.101P or S49.102P once the note names the arm, and to S49.11 through S49.14 once it names the Salter-Harris type<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Practice management software like Pabau keeps a refreshed ICD-10-CM library inside the chart, so the code you documented is the code you submit<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">Growth plate fractures do not always heal the way clinicians expect. When one sets crooked, the claim needs a very specific code. S49.109P names an unspecified physeal fracture of the lower end of the humerus, healed with a malunion. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Here&rsquo;s what the code actually means, and where practices go wrong.<\/p>\n\n\n\n<h2 id=\"h-what-icd-10-code-s49-109p-covers\" class=\"wp-block-heading\">What ICD-10 code S49.109P covers<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">ICD-10 code S49.109P reports an unspecified physeal fracture of the lower end of the humerus, unspecified arm, at a subsequent encounter for malunion. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In plain terms, a growth plate at the elbow end of the upper arm bone broke, and it healed crooked. The code is billable and specific, so it can carry a claim on its own.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe title=\"ICD-10 Revisions: Stay Updated or Fall Behind\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/bqAyb-BCA0w?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Two details in that descriptor cause most of the errors. The fracture sits at the lower end of the humerus, down by the elbow. And the 7th character P means malunion, while sequela carries S.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The code sits in Chapter 19 of ICD-10-CM, inside the S40-S49 block for injuries to the shoulder and upper arm. It has been valid since October 1, 2015, and the FY2026 edition carried it forward unchanged. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/icd-10-codes\" target=\"_blank\" rel=\"nofollow noopener\">Centers for Medicare and Medicaid Services<\/a> publishes the annual code files and the guidelines that govern the 7th character.<\/p>\n\n\n\n<h3 id=\"h-s49-109p-at-a-glance\" class=\"wp-block-heading\">S49.109P at a glance<\/h3>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.109P<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official long descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified physeal fracture of lower end of humerus, unspecified arm, subsequent encounter for fracture with malunion<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Short descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unsp physl fx low end humer, unsp arm, 7thP<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Chapter<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Block<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S40-S49: Injuries to the shoulder and upper arm<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49: Other and unspecified injuries of shoulder and upper arm<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Subcategory<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.1: Physeal fracture of lower end of humerus<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Billable<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes. Billable and specific in the FY2026 edition<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Encounter type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subsequent encounter for fracture with malunion (7th character P)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Salter-Harris type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Not specified in the record<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Laterality<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified. Use S49.101P for the right arm and S49.102P for the left<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Present on admission<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Exempt from POA reporting<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">MS-DRG grouping<\/td>\n<td style=\"padding:12px 16px;color:#374151\">564, 565 and 566: other musculoskeletal system and connective tissue diagnoses<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code history<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Effective October 1, 2015, with no revisions through the FY2026 edition<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h2 id=\"h-why-an-elbow-end-fracture-sits-in-a-shoulder-code-block\" class=\"wp-block-heading\">Why an elbow-end fracture sits in a shoulder code block<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">ICD-10-CM files fractures by the bone that broke, not by the nearest joint. The humerus is an upper arm bone, so every physeal fracture along it stays inside the S40-S49 block. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The S40-S49 block carries a Type 2 Excludes note that sends injuries of the elbow to S50-S59. So a coder who follows the deformity to the elbow and searches S50-S59 will never reach S49.109P. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Anatomically, the distal humeral physis is the growth plate just above the elbow joint. It supplies roughly 20% of the length of the humerus, while the growth plate at the shoulder end supplies the rest. It closes in the mid teens, around ages 14 to 16.<\/p>\n\n\n\n<h3 id=\"h-who-gets-this-injury-and-why-it-heals-crooked\" class=\"wp-block-heading\">Who gets this injury, and why it heals crooked<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The clinical picture behind this code is narrower than the descriptor suggests. That context is useful when you are reading a note.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Who it affects:<\/strong> the whole distal humeral physis separates most often in children under three, including newborns after a hard delivery<\/li>\n\n\n\n<li><strong>How it happens:<\/strong> birth trauma, a fall onto the arm, or a twisting force through the elbow<\/li>\n\n\n\n<li><strong>Safeguarding flag:<\/strong> one <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11752408\/\" target=\"_blank\" rel=\"nofollow noopener\">case series<\/a> puts the linked risk of child abuse at 13 times that of a supracondylar humerus fracture<\/li>\n\n\n\n<li><strong>Why imaging is hard:<\/strong> the epiphysis is still cartilage in infants, so plain films can look near normal. Ultrasound, MRI or arthrography confirms it<\/li>\n\n\n\n<li><strong>Why malunion follows:<\/strong> the injury reads as an elbow dislocation or a lateral condyle fracture, and an unreduced fracture unites in varus<\/li>\n\n\n\n<li><strong>What that looks like:<\/strong> cubitus varus, the gunstock deformity, reported in about one in five children in a <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC11942886\/\" target=\"_blank\" rel=\"nofollow noopener\">recent systematic review<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">None of that changes the code selection on its own. It does explain why the malunion character comes up so often at this site. It also explains why the note usually carries a deformity measurement worth reading before you code.<\/p>\n\n\n\n<h2 id=\"h-the-7th-character-p-says-the-fracture-healed-crooked\" class=\"wp-block-heading\">The 7th character P says the fracture healed crooked<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">P means the fracture united, but in a poor position. It is a subsequent care character, so the fracture is still the condition being managed at this visit. Nothing about P signals that the injury episode has closed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Six characters are valid across the S49.1 subcategory. Each one marks a different point on the same injury timeline.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">7th character<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Meaning<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When it applies<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active treatment: emergency assessment, reduction, casting, first fixation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">D<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subsequent encounter for fracture with routine healing<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Follow-up while the fracture heals as expected<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subsequent encounter for fracture with delayed healing<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Healing is slower than expected and union has not been reached<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">K<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subsequent encounter for fracture with nonunion<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The fracture has failed to unite<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subsequent encounter for fracture with malunion<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The fracture has united, but in a poor position<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Sequela<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A separate residual condition arising from the fracture<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Notice what is missing. No open fracture character exists in this subcategory, so every initial encounter is coded A, initial encounter for closed fracture. Gustilo based characters cover the forearm, the femur and the lower leg, and never the humerus.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <a href=\"https:\/\/www.cms.gov\/files\/document\/fy-2026-icd-10-cm-coding-guidelines.pdf\" target=\"_blank\" rel=\"nofollow noopener\">FY2026 ICD-10-CM Official Guidelines<\/a> are explicit about where malunion belongs. Section I.C.19.c.1 covers care of fracture complications such as malunion and nonunion. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It routes them to the subsequent care characters for nonunion (K, M, N) or malunion (P, Q, R). Aftercare Z codes never stand in for these characters.<\/p>\n\n\n\n<h2 id=\"h-how-malunion-p-differs-from-sequela-s\" class=\"wp-block-heading\">How malunion (P) differs from sequela (S)<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">P and S describe different stages, and the choice changes how the claim is sequenced. P says the bone united badly, and the bone is still the problem. S says the fracture episode has closed, and a separate condition it caused now needs treatment.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Question<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">7th character P<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">7th character S<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">What happened to the bone<\/td>\n<td style=\"padding:12px 16px;color:#374151\">It united, but in a poor position<\/td>\n<td style=\"padding:12px 16px;color:#374151\">It healed, and a distinct residual condition remains<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Reason for the encounter<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The malunion itself<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The residual condition<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Sequencing<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.109P stands alone as the diagnosis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Residual condition first, then S49.109S<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Typical picture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Varus angulation reviewed for corrective osteotomy<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Elbow stiffness treated in therapy long afterwards<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code for this site<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.109P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.109S<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Sequencing follows directly from that split. Guideline I.B.10 asks for two codes on a sequela claim, with the residual condition first and S49.109S second. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The 7th character S goes on the injury code only, never on the residual condition. Other shoulder injuries follow the same pattern, as <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s43121s\/\">ICD-10 code S43.121S<\/a> shows. A malunion claim needs no such pairing.<\/p>\n\n\n\n<h3 id=\"h-five-encounters-five-characters\" class=\"wp-block-heading\">Five encounters, five characters<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Working through a run of visits makes the boundary concrete.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Clinical picture<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Correct code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Why<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Toddler reviewed two weeks after reduction, healing on track<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.109D<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subsequent care during routine healing<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Radiographs at three months show union in varus angulation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.109P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">United, but in a poor position<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Fracture still ununited at six months, revision planned<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.109K<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Nonunion, not malunion<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Corrective osteotomy booked for the varus deformity<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.109P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Malunion care stays on the P character<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Therapy for stiffness once the fracture chapter is closed<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Stiffness code first, then S49.109S<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Residual condition is sequenced ahead of the injury<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Every row turns on the same thing: what the clinician wrote, rather than what the coder infers. That brings us to the detail that moves the code off the unspecified option.<\/p>\n\n\n\n<h2 id=\"h-how-the-salter-harris-type-changes-the-code\" class=\"wp-block-heading\">How the Salter-Harris type changes the code<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The Salter-Harris type sets the fifth character of the code. It sorts growth plate injuries by where the fracture line runs across the physis, the metaphysis and the epiphysis. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">ICD-10-CM maps types I to IV straight onto S49.11 through S49.14 for the lower end of the humerus.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Salter-Harris type<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Fracture plane<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Right arm<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Left arm<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Unspecified arm<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Type I<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Through the physis only<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.111P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.112P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.119P<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Type II<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Physis and metaphysis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.121P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.122P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.129P<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Type III<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Physis and epiphysis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.131P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.132P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.139P<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Type IV<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Physis, metaphysis and epiphysis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.141P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.142P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.149P<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Other specified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Documented pattern outside types I to IV<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.191P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.192P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.199P<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Not documented<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Type absent from the record<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.101P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.102P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.109P<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Every code in that table carries the 7th character P for malunion. Swap that character for A, D, G, K or S to describe a different encounter at the same site.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">S49.109P sits in the bottom right cell, and it should be the rare choice. If a radiology report or an operative note names the Salter-Harris type, code to it. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Where the record names the arm, code to that as well. Reaching for the unspecified code when both details sit in the chart is under-coding, and payers watch that pattern.<\/p>\n\n\n\n<h2 id=\"h-what-each-character-in-s49-109p-stands-for\" class=\"wp-block-heading\">What each character in S49.109P stands for<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Reading the code position by position shows which clinical detail each character carries. It also shows which characters stand in for information nobody wrote down.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Character<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Value<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Meaning<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Chapter 19: injury, poisoning and certain other consequences of external causes<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">2-3<\/td>\n<td style=\"padding:12px 16px;color:#374151\">49<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Category S49: other and unspecified injuries of shoulder and upper arm<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">4<\/td>\n<td style=\"padding:12px 16px;color:#374151\">1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subcategory S49.1: physeal fracture of the lower end of the humerus<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">5<\/td>\n<td style=\"padding:12px 16px;color:#374151\">0<\/td>\n<td style=\"padding:12px 16px;color:#374151\">S49.10: Salter-Harris type not specified<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">6<\/td>\n<td style=\"padding:12px 16px;color:#374151\">9<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Arm not specified<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">7<\/td>\n<td style=\"padding:12px 16px;color:#374151\">P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Subsequent encounter for fracture with malunion<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Two of those characters admit that the record is thin. The 0 in position five hides the Salter-Harris type, and the 9 in position six hides the arm. Both are defensible only when the detail is genuinely absent, so query the provider before you settle for either.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The <a href=\"https:\/\/icd10cmtool.cdc.gov\/\" target=\"_blank\" rel=\"nofollow noopener\">CDC ICD-10-CM tabular tool<\/a> shows the full entry if you want to check the alternatives.<\/p>\n\n\n\n<h2 id=\"h-neighboring-codes-that-get-picked-by-mistake\" class=\"wp-block-heading\">Neighboring codes that get picked by mistake<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The S49 category holds four subcategories and no more: S49.0, S49.1, S49.8 and S49.9. There is no S49.2 anywhere in ICD-10-CM. Any reference that files lower end physeal fractures under S49.2 is quoting a code that has never existed.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The pairing that does need care is S49.0 against S49.1. S49.0 is the upper end of the humerus, at the shoulder, and its unspecified arm malunion code is S49.009P. One word separates the two descriptors, so read the whole descriptor rather than the code number.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Descriptor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Use it when<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S49.101P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified physeal fracture of lower end of humerus, right arm, subsequent encounter for fracture with malunion<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The record names the right arm<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S49.102P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified physeal fracture of lower end of humerus, left arm, subsequent encounter for fracture with malunion<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The record names the left arm<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S49.109A<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified physeal fracture of lower end of humerus, unspecified arm, initial encounter for closed fracture<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The patient is in active treatment for the fracture<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S49.109S<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified physeal fracture of lower end of humerus, unspecified arm, sequela<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A separate residual condition is being treated<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S49.009P<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified physeal fracture of upper end of humerus, unspecified arm, subsequent encounter for fracture with malunion<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The growth plate involved is at the shoulder end<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S42.4-<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of lower end of humerus<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The break spares the growth plate, such as the simple supracondylar fracture at S42.41<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">S42.3-<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Fracture of shaft of humerus<\/td>\n<td style=\"padding:12px 16px;color:#374151\">The break sits in the middle of the bone<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Those last two rows matter because the tabular list points at them directly. S42.4 carries a Type 2 Excludes note sending physeal fractures of the lower end back to S49.1. A non-physeal malunion at the same site lands on <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s42409p\/\">ICD-10 code S42.409P<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">S42.3 carries the same note for both S49.0 and S49.1. Follow the Excludes note and you land on the right family every time.<\/p>\n\n\n\n<h2 id=\"h-what-the-note-has-to-say-before-you-use-p\" class=\"wp-block-heading\">What the note has to say before you use P<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A clean S49.109P claim rests on four statements in the record. The fracture involved the physis. It has united. It united in a poor position. And this visit is about that malposition.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Anything less, and the coder is guessing at the 7th character. Here is what a chart needs to carry:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Physeal involvement stated:<\/strong> the note names the growth plate or the distal humeral physis, rather than a generic elbow fracture<\/li>\n\n\n\n<li><strong>Union confirmed:<\/strong> imaging or a clinical statement showing the fracture has united, because malunion means healed, not healing<\/li>\n\n\n\n<li><strong>Malposition described:<\/strong> the direction and degree of the deformity, such as varus angulation measured on an AP elbow radiograph<\/li>\n\n\n\n<li><strong>Laterality recorded:<\/strong> which arm, so the coder can move to S49.101P or S49.102P instead of the unspecified code<\/li>\n\n\n\n<li><strong>Salter-Harris type carried forward:<\/strong> the type from the original imaging or operative report, copied into the current encounter note<\/li>\n\n\n\n<li><strong>Encounter purpose clear:<\/strong> whether the visit manages the malunion itself, which is P, or a separate residual condition, which is S<\/li>\n\n\n\n<li><strong>External cause noted:<\/strong> a secondary Chapter 20 code describing how the original injury happened, per the chapter note<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Much of that detail can land in the chart before the appointment even starts. <a href=\"https:\/\/pabau.com\/features\/patient-intake-software\/\">Digital intake forms<\/a> capture the fracture history and the affected arm up front, which saves the coder a chase later.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/diagnostic_codes\/icd-10-code-s49109p\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>Intake and consent forms in Pabau collect the fracture history and the affected arm before the appointment starts.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Before you assign P, find the sentence that confirms the fracture has united. Malunion means healed in the wrong position, so a note that describes deformity without confirming union usually supports G or K instead. One line in the radiology report settles it, and it takes seconds to ask for.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-how-an-s49-109p-claim-moves-and-what-stalls-it\" class=\"wp-block-heading\">How an S49.109P claim moves, and what stalls it<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">S49.109P is billable and specific, so it can stand as the first-listed diagnosis whenever the malunion is the reason for the visit. That is the practical difference from S49.109S, which always sits behind the residual condition it explains.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">On a malunion follow-up, the claim moves through four steps:<\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>The clinician documents union, the direction of the deformity, and the arm<\/li>\n\n\n\n<li>The coder reads that note and picks the 7th character, then the full code<\/li>\n\n\n\n<li>The biller attaches the CPT code for the work done at this visit<\/li>\n\n\n\n<li>The claim goes out, and the payer&rsquo;s <a href=\"https:\/\/pabau.com\/blog\/timely-filing-limits\/\">timely filing<\/a> clock runs from the date of service<\/li>\n<\/ol>\n\n\n\n<p class=\"wp-block-paragraph\">Three things stall that run. The note describes a deformity but never confirms union, which points to G or K. The arm appears in the imaging report and nowhere else. Or a corrective procedure gets booked before anyone checks whether the payer wants <a href=\"https:\/\/pabau.com\/blog\/prior-authorization-process\/\">prior authorization<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A few reimbursement points are worth keeping in view as well:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>No two-code rule:<\/strong> unlike a sequela claim, a malunion claim needs no residual condition in front of it<\/li>\n\n\n\n<li><strong>Surgery keeps the P character:<\/strong> an osteotomy to correct the deformity is still care of a fracture complication<\/li>\n\n\n\n<li><strong>POA exempt:<\/strong> the code is excluded from present on admission reporting, so inpatient abstracts skip the indicator<\/li>\n\n\n\n<li><strong>Inpatient grouping:<\/strong> S49.109P groups to MS-DRG 564, 565 or 566 for other musculoskeletal diagnoses<\/li>\n\n\n\n<li><strong>Specificity attracts attention:<\/strong> an unspecified type with an unspecified arm is the least precise option in the subcategory<\/li>\n\n\n\n<li><strong>CPT should match the service:<\/strong> code the work done for the malunion, not the original fracture care<\/li>\n<\/ul>\n\n\n\n<h3 id=\"h-before-you-submit-a-five-point-check\" class=\"wp-block-heading\">Before you submit: a five-point check<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Run these five questions over the chart before the claim leaves your queue.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Does the note say, in words, that the fracture has united?<\/li>\n\n\n\n<li>Does it name the arm, or does the imaging report name it for you?<\/li>\n\n\n\n<li>Is the Salter-Harris type recorded anywhere in the chart?<\/li>\n\n\n\n<li>Does the 7th character on the claim match the encounter the note describes?<\/li>\n\n\n\n<li>Did anyone run an <a href=\"https:\/\/pabau.com\/blog\/insurance-eligibility-verification\/\">eligibility check<\/a> before booking a corrective procedure?<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Denials on this code usually trace back to the same place. The note supported a different 7th character than the one submitted. Building that check into the pre-submission routine costs far less than appealing afterwards.<\/p>\n\n\n\n<h3 id=\"h-which-practices-report-this-code\" class=\"wp-block-heading\">Which practices report this code<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Pediatric orthopedic teams usually see it first, often at the three month review. Rehab picks it up next, and a <a href=\"https:\/\/pabau.com\/industry\/physical-therapy-emr\/\">physical therapy EMR<\/a> carries the same code across the visits that treat stiffness and lost range. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pabau.com\/industry\/sports-medicine-software\/\">Sports medicine practices<\/a> meet the same deformity years later, in an adolescent who broke an elbow as a toddler.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/diagnostic_codes\/icd-10-code-s49109p\/automate-claims-through-healthcode.webp\" alt=\"Automated claims and billing in Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Pabau pre-fills the claim from the codes already on the chart, so the 7th character you documented is the one you bill.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-how-pabau-keeps-the-code-and-the-claim-in-one-record\" class=\"wp-block-heading\">How Pabau keeps the code and the claim in one record<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most practices run this by hand. A coder reads the note, works out which 7th character fits, then looks the code up in a reference outside the patient record. Each re-key is another chance for S49.009P to appear where S49.109P belonged.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau closes that loop by keeping the reference inside the chart. Its ICD-10-CM and CPT libraries hold more than 20,000 codes, and they refresh with each official release. A coder can then search S49.1 without leaving the encounter. Codes recorded on the patient record then seed the claim form.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For an orthopedic or physical therapy practice, that means fewer re-keys and fewer claims returned for missing information. <a href=\"https:\/\/pabau.com\/features\/claims-management-software\/\">Pabau&rsquo;s claims management software<\/a> checks that claim-required fields are complete before submission unlocks. It also runs eligibility checks, tracks claim status, and posts remittances back to the same record.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Documentation is the other half of the problem, because a coder can only work with what was written down. <a href=\"https:\/\/pabau.com\/features\/ai-medical-scribe\/\">Pabau Scribe, our AI scribe<\/a>, drafts the consultation note as the appointment happens. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">On a malunion follow-up, the note has to confirm union, name the angulation, and say which arm. Those phrases only reach the claim if someone records them first.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/diagnostic_codes\/icd-10-code-s49109p\/creating-treatment-notes-with-echo-ai.webp\" alt=\"Creating treatment notes with Pabau Scribe\"\/><figcaption class=\"wp-element-caption\"><em>Pabau Scribe drafts the treatment note from the consultation, so union status and laterality reach the record.<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:35px;width:800px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Keep ICD-10 coding and claims in one system                <\/h3>\n\n                <p class=\"description\">\n                    Pabau puts a refreshed ICD-10-CM library inside the patient record. The claim form pre-fills from what you already documented, and required fields are checked before you submit.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-conclusion\" class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">S49.109P is a narrow code with two easy ways to get it wrong. The site is the lower end of the humerus, down at the elbow. And the 7th character P says the fracture healed crooked, rather than leaving a sequela behind. Confirm both before the claim leaves the building.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The moment the arm or the Salter-Harris type appears anywhere in the record, move to the specific sibling code. Leave the unspecified one behind. That habit is worth more than any appeal you win later.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau keeps the ICD-10-CM library and the clinical note in the same place, which makes that detail easy to find. <a href=\"https:\/\/pabau.com\/book-demo\/\">Book a demo<\/a> to see how your team could code fracture follow-ups and bill them from one record.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Coding another shoulder or upper arm injury?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s46191a\/\">ICD-10 code S46.191A<\/a> walks through the same 7th character logic at the initial encounter.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need the sequela side of the same chapter?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-s43312s\/\">ICD-10 code S43.312S<\/a> shows how a residual condition is sequenced ahead of the injury code.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing the surgery that follows a malunion?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-20690\/\">CPT code 20690<\/a> covers the external fixation side of the claim.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Want the wider billing picture?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/what-is-revenue-cycle-management\/\">Revenue cycle management<\/a> explains how a coded note turns into paid work.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Tightening up your billing routine?<\/strong> <a href=\"https:\/\/pabau.com\/blog\/medical-billing-compliance\/\">Medical billing compliance<\/a> covers the checks that keep audits quiet.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1787042682800\"><h3 class=\"schema-faq-question\">Does S49.109P need a placeholder X?<\/h3> <p class=\"schema-faq-answer\">No. S49.109 already runs to six characters, so the P lands in the seventh position on its own. A placeholder X is only needed when a code is shorter than six characters.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787042682801\"><h3 class=\"schema-faq-question\">How long can a fracture stay on the P character?<\/h3> <p class=\"schema-faq-answer\">There is no time limit. ICD-10-CM picks the 7th character by the care given at the visit, not by the months since the injury. A malunion treated years later still reports P.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787042682802\"><h3 class=\"schema-faq-question\">Can a provider who did not treat the original fracture use P?<\/h3> <p class=\"schema-faq-answer\">Yes. The 7th character describes the type of care at this encounter, not who delivered the first treatment. A second-opinion surgeon or a therapist still reports P for malunion care.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787042682803\"><h3 class=\"schema-faq-question\">Is S49.109P ever correct for an adult?<\/h3> <p class=\"schema-faq-answer\">Rarely. A physeal fracture needs an open growth plate, and the distal humeral physis closes in the mid teens. An adult break at that site belongs in S42.4- instead.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1787042682804\"><h3 class=\"schema-faq-question\">What if the note says malunion but never mentions the growth plate?<\/h3> <p class=\"schema-faq-answer\">Code the site the record actually supports. Without documented physeal involvement, a malunited fracture of the lower end of the humerus sits in S42.4- with the P character.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>Growth plate fractures do not always heal the way clinicians expect. When one sets crooked, the claim needs a very specific code. S49.109P names an unspecified physeal fracture of the lower end of the humerus, healed with a malunion. Here&rsquo;s what the code actually means, and where practices go wrong. What ICD-10 code S49.109P covers [&hellip;]<\/p>\n","protected":false},"author":85,"featured_media":183547,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"82","_yoast_wpseo_content_score":"90","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1549,1550],"tags":[2775,1305,1666,3738],"class_list":["post-183548","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-diagnostic-codes","category-icd-10-cm","tag-fracture-management","tag-icd-10-codes","tag-orthopedic-billing","tag-pediatric-coding"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>ICD-10 code S49.109P: Distal humerus growth plate malunion<\/title>\n<meta name=\"description\" content=\"S49.109P covers a distal humerus growth plate fracture that healed crooked. See 7th character rules, sibling codes, and documentation.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/fr\/diagnostic-codes\/icd-10-code-s49109p\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ICD-10 code S49.109P: Distal humerus growth plate malunion\" \/>\n<meta property=\"og:description\" content=\"S49.109P covers a distal humerus growth plate fracture that healed crooked. See 7th character rules, sibling codes, and documentation.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/fr\/diagnostic-codes\/icd-10-code-s49109p\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-08-18T09:01:57+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-18T10:59:49+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/08\/icd-10-code-s49109p.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Monika Lazarevska\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"Monika Lazarevska\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data2\" content=\"15 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/\"},\"author\":{\"name\":\"Monika Lazarevska\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#\\\/schema\\\/person\\\/5763062f66fccbf75a390f99ee0b985a\"},\"headline\":\"ICD-10 code S49.109P: Distal humerus growth plate malunion\",\"datePublished\":\"2026-08-18T09:01:57+00:00\",\"dateModified\":\"2026-08-18T10:59:49+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/\"},\"wordCount\":3243,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/icd-10-code-s49109p.webp\",\"keywords\":[\"Fracture management\",\"ICD-10 codes\",\"Orthopedic Billing\",\"Pediatric coding\"],\"articleSection\":[\"Diagnostic Codes\",\"ICD-10-CM\"],\"inLanguage\":\"fr-FR\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/\",\"name\":\"ICD-10 code S49.109P: Distal humerus growth plate malunion\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/icd-10-code-s49109p.webp\",\"datePublished\":\"2026-08-18T09:01:57+00:00\",\"dateModified\":\"2026-08-18T10:59:49+00:00\",\"description\":\"S49.109P covers a distal humerus growth plate fracture that healed crooked. 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It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.\",\"foundingDate\":\"2011-10-20\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"201\",\"maxValue\":\"500\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#\\\/schema\\\/person\\\/5763062f66fccbf75a390f99ee0b985a\",\"name\":\"Monika Lazarevska\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/cropped-Monika-Lazarevska-skala-2-1-e1783430903842-1-96x96.jpg\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/cropped-Monika-Lazarevska-skala-2-1-e1783430903842-1-96x96.jpg\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/cropped-Monika-Lazarevska-skala-2-1-e1783430903842-1-96x96.jpg\",\"caption\":\"Monika Lazarevska\"},\"description\":\"Monika Lazarevska writes content for owners and healthcare professionals who want clear, no-fluff content that actually helps them run their practice better. With a background in storytelling and SEO, she knows how to make even the driest topics worth reading. Off the clock, you'll find her in a caf\u00e9 somewhere in Europe, probably with a good book and an even better coffee.\",\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/blog\\\/author\\\/monika-lazarevska\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/#faq-question-1787042682800\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/#faq-question-1787042682800\",\"name\":\"Does S49.109P need a placeholder X?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"No. S49.109 already runs to six characters, so the P lands in the seventh position on its own. A placeholder X is only needed when a code is shorter than six characters.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/#faq-question-1787042682801\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/#faq-question-1787042682801\",\"name\":\"How long can a fracture stay on the P character?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"There is no time limit. ICD-10-CM picks the 7th character by the care given at the visit, not by the months since the injury. A malunion treated years later still reports P.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/#faq-question-1787042682802\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/#faq-question-1787042682802\",\"name\":\"Can a provider who did not treat the original fracture use P?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Yes. The 7th character describes the type of care at this encounter, not who delivered the first treatment. A second-opinion surgeon or a therapist still reports P for malunion care.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/#faq-question-1787042682803\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/#faq-question-1787042682803\",\"name\":\"Is S49.109P ever correct for an adult?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Rarely. A physeal fracture needs an open growth plate, and the distal humeral physis closes in the mid teens. An adult break at that site belongs in S42.4- instead.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/#faq-question-1787042682804\",\"position\":5,\"url\":\"https:\\\/\\\/pabau.com\\\/fr\\\/diagnostic-codes\\\/icd-10-code-s49109p\\\/#faq-question-1787042682804\",\"name\":\"What if the note says malunion but never mentions the growth plate?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Code the site the record actually supports. Without documented physeal involvement, a malunited fracture of the lower end of the humerus sits in S42.4- with the P character.\",\"inLanguage\":\"fr-FR\"},\"inLanguage\":\"fr-FR\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"ICD-10 code S49.109P: Distal humerus growth plate malunion","description":"S49.109P covers a distal humerus growth plate fracture that healed crooked. See 7th character rules, sibling codes, and documentation.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/pabau.com\/fr\/diagnostic-codes\/icd-10-code-s49109p\/","og_locale":"fr_FR","og_type":"article","og_title":"ICD-10 code S49.109P: Distal humerus growth plate malunion","og_description":"S49.109P covers a distal humerus growth plate fracture that healed crooked. 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With a background in storytelling and SEO, she knows how to make even the driest topics worth reading. Off the clock, you'll find her in a caf\u00e9 somewhere in Europe, probably with a good book and an even better coffee.","url":"https:\/\/pabau.com\/fr\/blog\/author\/monika-lazarevska\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/diagnostic-codes\/icd-10-code-s49109p\/#faq-question-1787042682800","position":1,"url":"https:\/\/pabau.com\/fr\/diagnostic-codes\/icd-10-code-s49109p\/#faq-question-1787042682800","name":"Does S49.109P need a placeholder X?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"No. S49.109 already runs to six characters, so the P lands in the seventh position on its own. A placeholder X is only needed when a code is shorter than six characters.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/diagnostic-codes\/icd-10-code-s49109p\/#faq-question-1787042682801","position":2,"url":"https:\/\/pabau.com\/fr\/diagnostic-codes\/icd-10-code-s49109p\/#faq-question-1787042682801","name":"How long can a fracture stay on the P character?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"There is no time limit. ICD-10-CM picks the 7th character by the care given at the visit, not by the months since the injury. A malunion treated years later still reports P.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/diagnostic-codes\/icd-10-code-s49109p\/#faq-question-1787042682802","position":3,"url":"https:\/\/pabau.com\/fr\/diagnostic-codes\/icd-10-code-s49109p\/#faq-question-1787042682802","name":"Can a provider who did not treat the original fracture use P?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Yes. The 7th character describes the type of care at this encounter, not who delivered the first treatment. A second-opinion surgeon or a therapist still reports P for malunion care.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/diagnostic-codes\/icd-10-code-s49109p\/#faq-question-1787042682803","position":4,"url":"https:\/\/pabau.com\/fr\/diagnostic-codes\/icd-10-code-s49109p\/#faq-question-1787042682803","name":"Is S49.109P ever correct for an adult?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Rarely. A physeal fracture needs an open growth plate, and the distal humeral physis closes in the mid teens. An adult break at that site belongs in S42.4- instead.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"},{"@type":"Question","@id":"https:\/\/pabau.com\/fr\/diagnostic-codes\/icd-10-code-s49109p\/#faq-question-1787042682804","position":5,"url":"https:\/\/pabau.com\/fr\/diagnostic-codes\/icd-10-code-s49109p\/#faq-question-1787042682804","name":"What if the note says malunion but never mentions the growth plate?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Code the site the record actually supports. Without documented physeal involvement, a malunited fracture of the lower end of the humerus sits in S42.4- with the P character.","inLanguage":"fr-FR"},"inLanguage":"fr-FR"}]}},"yoast":{"focus_keyword":"ICD-10 code S49.109P","seo_title":"ICD-10 code S49.109P: Distal humerus growth plate malunion","meta_description":"S49.109P covers a distal humerus growth plate fracture that healed crooked. 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