Version 2024

2024 ICD-10-CM Diagnosis Code S42

Fracture of shoulder and upper arm

ICD-10-CM Code:
S42
ICD-10 Code for:
Fracture of shoulder and upper arm
Is Billable?
Not Valid for Submission
Code Navigator:

Code Classification

  • Injury, poisoning and certain other consequences of external causes
    (S00–T88)
    • Injuries to the shoulder and upper arm
      (S40-S49)
      • Fracture of shoulder and upper arm
        (S42)

S42 is a non-specific and non-billable diagnosis code code, consider using a code with a higher level of specificity for a diagnosis of fracture of shoulder and upper arm. The code is not specific and is NOT valid for the year 2024 for the submission of HIPAA-covered transactions. Category or Header define the heading of a category of codes that may be further subdivided by the use of 4th, 5th, 6th or 7th characters.

Specific Coding Applicable to Fracture of shoulder and upper arm

Non-specific codes like S42 require more digits to indicate the appropriate level of specificity. Consider using any of the following ICD-10-CM codes with a higher level of specificity when coding for fracture of shoulder and upper arm:

  • S42.0 for Fracture of clavicle - NON-BILLABLE CODE

  • S42.00 for Fracture of unspecified part of clavicle - NON-BILLABLE CODE

  • S42.01 for Fracture of sternal end of clavicle - NON-BILLABLE CODE

  • S42.02 for Fracture of shaft of clavicle - NON-BILLABLE CODE

  • S42.03 for Fracture of lateral end of clavicle - NON-BILLABLE CODE

  • S42.1 for Fracture of scapula - NON-BILLABLE CODE

  • S42.10 for Fracture of unspecified part of scapula - NON-BILLABLE CODE

  • S42.11 for Fracture of body of scapula - NON-BILLABLE CODE

  • S42.12 for Fracture of acromial process - NON-BILLABLE CODE

  • S42.13 for Fracture of coracoid process - NON-BILLABLE CODE

  • S42.14 for Fracture of glenoid cavity of scapula - NON-BILLABLE CODE

  • S42.15 for Fracture of neck of scapula - NON-BILLABLE CODE

  • S42.19 for Fracture of other part of scapula - NON-BILLABLE CODE

  • S42.2 for Fracture of upper end of humerus - NON-BILLABLE CODE

  • S42.20 for Unspecified fracture of upper end of humerus - NON-BILLABLE CODE

  • S42.21 for Unspecified fracture of surgical neck of humerus - NON-BILLABLE CODE

  • S42.22 for 2-part fracture of surgical neck of humerus - NON-BILLABLE CODE

  • S42.23 for 3-part fracture of surgical neck of humerus - NON-BILLABLE CODE

  • S42.24 for 4-part fracture of surgical neck of humerus - NON-BILLABLE CODE

  • S42.25 for Fracture of greater tuberosity of humerus - NON-BILLABLE CODE

  • S42.26 for Fracture of lesser tuberosity of humerus - NON-BILLABLE CODE

  • S42.27 for Torus fracture of upper end of humerus - NON-BILLABLE CODE

  • S42.29 for Other fracture of upper end of humerus - NON-BILLABLE CODE

  • S42.3 for Fracture of shaft of humerus - NON-BILLABLE CODE

  • S42.30 for Unspecified fracture of shaft of humerus - NON-BILLABLE CODE

  • S42.31 for Greenstick fracture of shaft of humerus - NON-BILLABLE CODE

  • S42.32 for Transverse fracture of shaft of humerus - NON-BILLABLE CODE

  • S42.33 for Oblique fracture of shaft of humerus - NON-BILLABLE CODE

  • S42.34 for Spiral fracture of shaft of humerus - NON-BILLABLE CODE

  • S42.35 for Comminuted fracture of shaft of humerus - NON-BILLABLE CODE

  • S42.36 for Segmental fracture of shaft of humerus - NON-BILLABLE CODE

  • S42.39 for Other fracture of shaft of humerus - NON-BILLABLE CODE

  • S42.4 for Fracture of lower end of humerus - NON-BILLABLE CODE

  • S42.40 for Unspecified fracture of lower end of humerus - NON-BILLABLE CODE

  • S42.41 for Simple supracondylar fracture without intercondylar fracture of humerus - NON-BILLABLE CODE

  • S42.42 for Comminuted supracondylar fracture without intercondylar fracture of humerus - NON-BILLABLE CODE

  • S42.43 for Fracture (avulsion) of lateral epicondyle of humerus - NON-BILLABLE CODE

  • S42.44 for Fracture (avulsion) of medial epicondyle of humerus - NON-BILLABLE CODE

  • S42.45 for Fracture of lateral condyle of humerus - NON-BILLABLE CODE

  • S42.46 for Fracture of medial condyle of humerus - NON-BILLABLE CODE

  • S42.47 for Transcondylar fracture of humerus - NON-BILLABLE CODE

  • S42.48 for Torus fracture of lower end of humerus - NON-BILLABLE CODE

  • S42.49 for Other fracture of lower end of humerus - NON-BILLABLE CODE

  • S42.9 for Fracture of shoulder girdle, part unspecified - NON-BILLABLE CODE

  • S42.90 for Fracture of unspecified shoulder girdle, part unspecified - NON-BILLABLE CODE

  • S42.91 for Fracture of right shoulder girdle, part unspecified - NON-BILLABLE CODE

  • S42.92 for Fracture of left shoulder girdle, part unspecified - NON-BILLABLE CODE

Coding Guidelines

The principles of multiple coding of injuries should be followed in coding fractures. Fractures of specified sites are coded individually by site nd the level of detail furnished by medical record content.

A fracture not indicated as open or closed should be coded to closed. A fracture not indicated whether displaced or not displaced should be coded to displaced.

Initial vs. Subsequent Encounter for Fractures

Traumatic fractures are coded using the appropriate 7th character for initial encounter (A, B, C) for each encounter where the patient is receiving active treatment for the fracture. The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.

Fractures are coded using the appropriate 7th character for subsequent care for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase.

Care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes.

Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate 7th character for subsequent care with nonunion (K, M, N,) or subsequent care with malunion (P, Q, R).

Malunion/nonunion: The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.

The open fracture designations in the assignment of the 7th character for fractures of the forearm, femur and lower leg, including ankle are based on the Gustilo open fracture classification. When the Gustilo classification type is not specified for an open fracture, the 7th character for open fracture type I or II should be assigned (B, E, H, M, Q).

Tabular List of Diseases and Injuries

The following annotation back-references are applicable to this diagnosis code. The Tabular List of Diseases and Injuries is a list of ICD-10-CM codes, organized "head to toe" into chapters and sections with coding notes and guidance for inclusions, exclusions, descriptions and more.


Type 1 Excludes

Type 1 Excludes
A type 1 excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
  • traumatic amputation of shoulder and upper arm S48

Type 2 Excludes

Type 2 Excludes
A type 2 excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
  • periprosthetic fracture around internal prosthetic shoulder joint M97.3

7th Character Note

7th Character Note
Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters.
  • The appropriate 7th character is to be added to all codes from category S42

7th Character

7th Character
Indicates that a seventh character is to be assigned to codes in a subcategory.
  • A - initial encounter for closed fracture
  • B - initial encounter for open fracture
  • D - subsequent encounter for fracture with routine healing
  • G - subsequent encounter for fracture with delayed healing
  • K - subsequent encounter for fracture with nonunion
  • P - subsequent encounter for fracture with malunion
  • S - sequela

  • A fracture not indicated as displaced or nondisplaced should be coded to displaced
  • A fracture not indicated as open or closed should be coded to closed

Patient Education


Fractures

A fracture is a break, usually in a bone. If the broken bone punctures the skin, it is called an open or compound fracture. Fractures commonly happen because of car accidents, falls, or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Overuse can cause stress fractures, which are very small cracks in the bone.

Symptoms of a fracture are:

  • Intense pain
  • Deformity - the limb looks out of place
  • Swelling, bruising, or tenderness around the injury
  • Numbness and tingling
  • Problems moving a limb

You need to get medical care right away for any fracture. An x-ray can tell if your bone is broken. You may need to wear a cast or splint. Sometimes you need surgery to put in plates, pins or screws to keep the bone in place.


[Learn More in MedlinePlus]

Shoulder Injuries and Disorders

Your shoulder joint is composed of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). Your shoulders are the most movable joints in your body. They can also be unstable because the ball of the upper arm is larger than the shoulder socket that holds it. To remain in a stable or normal position, the shoulder must be anchored by muscles, tendons, and ligaments.

Because your shoulder can be unstable, it can be easily injured. Common problems include:

  • Sprains and strains
  • Dislocations
  • Separations
  • Tendinitis
  • Bursitis
  • Torn rotator cuffs
  • Frozen shoulder
  • Fractures (broken bones)
  • Arthritis

Health care providers diagnose shoulder problems by using your medical history, a physical exam, and imaging tests.

Often, the first treatment for shoulder problems is RICE. This stands for Rest, Ice, Compression, and Elevation. Other treatments include exercise and medicines to reduce pain and swelling. If those don't work, you may need surgery.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases


[Learn More in MedlinePlus]

Code History

  • FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
  • FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
  • FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
  • FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.