Is ICD-10-CM code S26 billable?

No, S26 (Injury of heart) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code S26 belong to?

S26 belongs to Chapter 19 of the ICD-10-CM tabular list: S00–T88 (Injury, Poisoning and Certain Other Consequences of External Causes).

S26Not billable, use a more specific code below

Injury of heart

In Injuries to the thorax (S20-S29), chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes

42 billable codes under S26: 5 are an MCC, 9 are a CC; none map to an HCC.A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment.

Instructional notes

Code also: add a code for this too, order depends on the encounter

any associated:
open wound of thorax (S21.-)
traumatic hemopneumothorax (S27.2)
traumatic hemothorax (S27.1)
traumatic pneumothorax (S27.0)

Also applies, from Injuries to the thorax (S20-S29)

These notes sit on S20-S29 and apply to every code under it, including S26.

Includes: conditions that are coded here

injuries of breast
injuries of chest (wall)
injuries of interscapular area

Excludes2: not included here, code separately if applicable

burns and corrosions (T20-T32)
effects of foreign body in bronchus (T17.5)
effects of foreign body in esophagus (T18.1)
effects of foreign body in lung (T17.8)
effects of foreign body in trachea (T17.4)
frostbite (T33-T34)
injuries of axilla
injuries of clavicle
injuries of scapular region
injuries of shoulder
insect bite or sting, venomous (T63.4)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Covers 7th character use and coding of injuries, fractures, burns, drug and toxic effects, abuse and neglect, and complications of care (S00-T88).

Application of 7th Characters in Chapter 19 (page 77)
Coding of Injuries (page 78)
Coding of Traumatic Fractures (page 79)
Coding of Burns and Corrosions (page 80)
Adverse Effects, Poisoning, Underdosing and Toxic Effects (page 82)
Adult and child abuse, neglect and other maltreatment (page 85)
Complications of care (page 85)

Read Section I.C.19 (page 77)

All codes under S26

S26 can't be used on a claim. Pick a billable code below; grey headings group them.

S26 MS-DRGs

As the principal diagnosis, the billable codes under S26 group to these 10 MS-DRGs (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 205 Other Respiratory System Diagnoses with MCC (14 of 42 codes)
DRG 206 Other Respiratory System Diagnoses without MCC (14 of 42 codes)
DRG 314 Other Circulatory System Diagnoses with MCC (14 of 42 codes)
DRG 315 Other Circulatory System Diagnoses with CC (14 of 42 codes)
DRG 316 Other Circulatory System Diagnoses without CC/MCC (14 of 42 codes)
DRG 949 Aftercare with CC/MCC (14 of 42 codes)
DRG 950 Aftercare without CC/MCC (14 of 42 codes)
DRG 963 Other Multiple Significant Trauma with MCC (14 of 42 codes)
DRG 964 Other Multiple Significant Trauma with CC (14 of 42 codes)
DRG 965 Other Multiple Significant Trauma without CC/MCC (14 of 42 codes)

Other codes that refer to S26

Notes on these codes point to S26.

I31 Excludes1: traumatic injury to pericardium (S26.-)
I5A Excludes1: injury of heart (S26.-)
S21 Code Also: injury of heart (S26.-)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Chest Injuries and Disorders

The chest is the part of your body between your neck and your abdomen (belly). The medical term for your chest is thorax. Your chest holds many important structures for breathing, digestion, blood circulation, and other important body functions. These structures include your:

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.