Glossary · Clinical

Salter-Harris classification

The Salter-Harris classification is a five-type system that categorizes pediatric physeal (growth-plate) fractures by the anatomic path of the fracture line, with higher type numbers generally indicating greater involvement of the epiphysis and greater risk of growth disturbance.

Verified May 8, 2026 · 6 sources ↓

Drawn from CMSAAPCAcdisICD10Data

Definition

Source · Editorial summary grounded in 6 cited references ↓

The Salter-Harris system organizes growth-plate fractures in skeletally immature patients into five types based on where the fracture line travels relative to the physis, metaphysis, and epiphysis. Type I is a transverse shear through the physis only; Type II extends through the physis and exits through the metaphysis (the most common pattern); Type III crosses the physis and exits through the epiphysis into the joint; Type IV cuts vertically through the metaphysis, physis, and epiphysis; and Type V is a crush injury to the physis itself, often invisible on initial radiographs and diagnosed retrospectively when growth arrest becomes apparent.

The clinical importance of the classification lies in its predictive value for growth disturbance and its direct influence on treatment selection. Types I and II are generally managed with closed reduction and have a favorable prognosis. Types III and IV involve the articular surface and frequently require open reduction and internal fixation to restore joint congruity and minimize the risk of physeal bar formation. Type V carries the highest risk of premature growth arrest regardless of treatment.

From a documentation and billing standpoint, each Salter-Harris type maps to a distinct ICD-10-CM code series. ICD-10-CM uses the construct 'Salter-Harris Type [I–IV] physeal fracture of [anatomic site], [laterality], [encounter type]' as the code description. A fifth type is captured under 'other physeal fracture' codes rather than a named Type V designation in the current code set. Accurate type assignment in the operative or emergency note is therefore prerequisite to correct code selection and appropriate reimbursement.

Why it matters

Selecting the wrong Salter-Harris type code is not a minor clerical error—it changes the diagnosis code entirely, alters DRG assignment under CMS MS-DRG logic, and can trigger a medical necessity denial if the documented type does not support the procedure billed. For example, billing an open reduction CPT code (e.g., 27827 or 27828 for the distal tibia) against a Type I or II diagnosis code may flag as inconsistent, because payers expect closed treatment for most low-grade physeal fractures unless documentation explicitly justifies operative intervention. Conversely, under-coding a Type III or IV as a Type II obscures the intra-articular extension, potentially supporting a lower-complexity E/M or procedure code and leaving reimbursement on the table while creating a mismatch if the record is audited.

Common mistakes

Where people most often go wrong with this concept.

Source · Editorial brief grounded in cited references ↓

Assigning 'Type II' by default when the fracture type is not explicitly documented, rather than querying the treating provider or using the unspecified physeal fracture code.
Confusing Type III (epiphyseal exit, intra-articular) with Type IV (transphyseal, both metaphysis and epiphysis) because both involve the epiphysis—misclassification here changes the procedure code justification and reimbursement.
Using an unspecified physeal fracture code (e.g., S89.109A) when the operative or imaging report clearly names the Salter-Harris type, leaving specificity—and potentially reimbursement—on the table.
Failing to append the correct seventh-character encounter type (A = initial, D = subsequent routine healing, G = subsequent delayed healing, S = sequela), which is required on every Salter-Harris code and is a common claim edit failure.
Coding a presumptive Type V fracture at the initial encounter when imaging is normal; Type V is typically a retrospective diagnosis and should not be coded until growth arrest is confirmed.
Reporting a separate physeal fracture code alongside a named Salter-Harris code for the same fracture at the same site—Coding Clinic guidance specifies that a single physeal fracture requires only one code.

Related codes

Codes commonly involved when this concept appears in practice.

CPT

Modifiers

LT Left side RT Right side 59 Distinct procedural service

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Which Salter-Harris type is most common, and why does it matter for coding?

Type II—where the fracture line traverses the physis and exits through the metaphysis—is the most frequently encountered pattern, particularly at the distal tibia and distal radius. It matters for coding because it has its own discrete ICD-10-CM code series (e.g., S89.121A for the lower tibia), and defaulting to Type II when the type is undocumented is a compliance risk; the unspecified physeal fracture code should be used instead until the provider documents the type.

02Is there an ICD-10-CM code specifically for Salter-Harris Type V?

No. The current ICD-10-CM code set names only Types I through IV with the 'Salter-Harris' descriptor. Type V crush injuries to the physis are captured under 'other physeal fracture' codes (e.g., S89.191A). Additionally, Type V is often a retrospective diagnosis made after growth arrest is identified, so it should not be coded at an initial encounter based on clinical suspicion alone.

03Can a single fracture require both a Salter-Harris code and a separate physeal fracture code?

No. Coding Clinic guidance specifies that a single physeal fracture at one site should be reported with only one code. Assigning both a named Salter-Harris type code and an unspecified physeal fracture code for the same injury at the same site constitutes duplicate coding and should be avoided.

04How does Salter-Harris type affect CPT code selection for the distal tibia?

Treatment approach—and therefore CPT code—is directly influenced by type. Types I and II are usually managed with closed reduction (CPT 27824 for closed treatment without manipulation, 27825 with manipulation), while Types III and IV, which involve the articular surface, more often require open or percutaneous fixation (CPT 27826, 27827, or 27828). If the procedure code implies operative intervention but the diagnosis code reflects a low-grade type, payers may question medical necessity without clear supporting documentation.

05What seventh character should be used for a Salter-Harris fracture seen at a follow-up visit where healing is progressing normally?

Use the seventh character 'D' (subsequent encounter for fracture with routine healing). The character 'A' is reserved for the initial encounter when active treatment is being rendered. Follow-up visits during normal healing require 'D,' while delayed healing uses 'G' and sequela uses 'S.' Applying 'A' to a follow-up visit is a frequent edit failure.

06Do Salter-Harris fracture codes apply to adult patients?

In rare cases, yes—adults who have not yet achieved complete skeletal maturity may present with physeal fractures. The codes are not strictly age-gated in ICD-10-CM. However, a Salter-Harris code assigned to an adult patient with a closed physis may draw payer scrutiny, so documentation should confirm residual physeal activity when the code is used outside the typical pediatric age range.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

When Mira detects 'Salter-Harris' in a clinical note, it prompts the following documentation logic before finalizing the encounter code: 1. TYPE SPECIFICITY: Confirm the treating provider has explicitly stated the Salter-Harris type (I–IV or 'other/unspecified'). If the note says only 'physeal fracture' or 'growth-plate fracture' without a type, Mira flags for provider query before code assignment. 2. ANATOMIC SITE + LATERALITY: Mira extracts the bone and side from the note (e.g., 'distal tibia, left') to match the correct ICD-10-CM code branch. Ambiguous site references trigger a clarification flag. 3. ENCOUNTER CHARACTER: Mira assigns the seventh character based on the encounter context captured in the note header—initial (A), subsequent with routine healing (D), subsequent with delayed healing (G), or sequela (S). It does not default to 'A' for follow-up visits. 4. PROCEDURE ALIGNMENT CHECK: Mira cross-checks the Salter-Harris type against the selected CPT code. A Type I or II diagnosis paired with an open-reduction CPT code generates a soft alert requesting documentation of the clinical rationale (e.g., failed closed reduction, neurovascular compromise). 5. TYPE V GUARD: If the note suggests a compression mechanism with normal initial imaging in a child, Mira prompts the provider to defer Type V coding and instead use the unspecified physeal fracture code until growth arrest is radiographically confirmed at follow-up. 6. DUPLICATE CODE PREVENTION: Mira suppresses secondary 'unspecified physeal fracture' codes when a named Salter-Harris type code is already assigned for the same site and encounter, consistent with Coding Clinic guidance.

See Mira's approach

Open reduction internal fixation (ORIF) is surgery in which an orthopedic surgeon makes an incision to reposition fractured bone fragments and then secures them with hardware—screws, plates, rods, or wires—so the bone heals in correct anatomic alignment.