2027 ICD-10-CM Diagnosis Code S42Fracture of shoulder and upper arm

ICD-10-CM Codes›S00–T88›S40-S49›S42

ICD-10-CM S42
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

S42 is a non-billable ICD-10-CM category code for fracture of shoulder and upper arm, so it cannot be submitted on claims. Use a more specific code from this category instead, such as S42.001A, S42.001B, S42.001D, and S42.001G.

Code Identity

ICD-10-CM Code
S42
Billable Status
No — Non-Billable Category
Code Describes
Fracture of shoulder and upper arm
Short Description
Fracture of shoulder and upper arm
Same as the full description in the CMS dataset.
Chapter
S40-S49
Injuries to the shoulder and upper arm

Code Classification

ChapterS00–T88Injury, poisoning and certain other consequences of external causes
SectionS40-S49Injuries to the shoulder and upper arm
CategoryS42Fracture of shoulder and upper arm
This CodeS42Fracture of shoulder and upper arm

Specific Coding for Fracture of shoulder and upper armOverview

Non-specific codes like S42 require more characters. Use one of these billable codes instead:

  • S42.0 for Fracture of clavicle

  • S42.00 for Fracture of unspecified part of clavicle

  • S42.01 for Fracture of sternal end of clavicle

  • S42.02 for Fracture of shaft of clavicle

  • S42.03 for Fracture of lateral end of clavicle

  • S42.1 for Fracture of scapula

  • S42.10 for Fracture of unspecified part of scapula

  • S42.11 for Fracture of body of scapula

  • S42.12 for Fracture of acromial process

  • S42.13 for Fracture of coracoid process

  • S42.14 for Fracture of glenoid cavity of scapula

  • S42.15 for Fracture of neck of scapula

  • S42.19 for Fracture of other part of scapula

  • S42.2 for Fracture of upper end of humerus

  • S42.20 for Unspecified fracture of upper end of humerus

  • S42.21 for Unspecified fracture of surgical neck of humerus

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

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

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

  • S42.25 for Fracture of greater tuberosity of humerus

  • S42.26 for Fracture of lesser tuberosity of humerus

  • S42.27 for Torus fracture of upper end of humerus

  • S42.29 for Other fracture of upper end of humerus

  • S42.3 for Fracture of shaft of humerus

  • S42.30 for Unspecified fracture of shaft of humerus

  • S42.31 for Greenstick fracture of shaft of humerus

  • S42.32 for Transverse fracture of shaft of humerus

  • S42.33 for Oblique fracture of shaft of humerus

  • S42.34 for Spiral fracture of shaft of humerus

  • S42.35 for Comminuted fracture of shaft of humerus

  • S42.36 for Segmental fracture of shaft of humerus

  • S42.39 for Other fracture of shaft of humerus

  • S42.4 for Fracture of lower end of humerus

  • S42.40 for Unspecified fracture of lower end of humerus

  • S42.41 for Simple supracondylar fracture without intercondylar fracture of humerus

  • S42.42 for Comminuted supracondylar fracture without intercondylar fracture of humerus

  • S42.43 for Fracture (avulsion) of lateral epicondyle of humerus

  • S42.44 for Fracture (avulsion) of medial epicondyle of humerus

  • S42.45 for Fracture of lateral condyle of humerus

  • S42.46 for Fracture of medial condyle of humerus

  • S42.47 for Transcondylar fracture of humerus

  • S42.48 for Torus fracture of lower end of humerus

  • S42.49 for Other fracture of lower end of humerus

  • S42.9 for Fracture of shoulder girdle, part unspecified

  • S42.90 for Fracture of unspecified shoulder girdle, part unspecified

  • S42.91 for Fracture of right shoulder girdle, part unspecified

  • S42.92 for Fracture of left shoulder girdle, part unspecified

Coding GuidelinesGuidance

The principles of multiple coding of injuries should be followed in coding fractures. Fractures of specified sites are coded individually by site, to 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) while 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).

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).

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, published by CMS and the National Center for Health Statistics.

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to S42: its own notes plus those printed at block S40-S49 and Chapter 19. A note printed at a category, block or chapter applies to every code under it.

Includes

Further defines, or gives examples of, the content of the category.

From Block S40-S49 Injuries to the shoulder and upper arm applies to 2,730 codes
  • injuries of axilla
  • injuries of scapular region

Excludes1

Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.

  • traumatic amputation of shoulder and upper arm (S48.-)

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

On S42 itself
  • periprosthetic fracture around internal prosthetic shoulder joint (M97.3)
From Block S40-S49 Injuries to the shoulder and upper arm applies to 2,730 codes
From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes

Use Additional Code

Add a second code, after this one, to fully describe the condition.

From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes
  • code to identify any retained foreign body, if applicable (Z18.-)

Notes

General instructions on how these codes are used.

On S42 itself
  • 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
From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes
  • Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code
  • The chapter uses the S-section for coding different types of injuries related to single body regions and the T-section to cover injuries to unspecified body regions as well as poisoning and certain other consequences of external causes.

7th Character

Every code in the category takes a 7th character from the listed values, with the placeholder X filling any empty positions before it.

  • The appropriate 7th character is to be added to all codes from category S42
Values for category S42 Open or Closed Fracture Encounter
  • Ainitial encounter for closed fracture
  • Binitial encounter for open fracture
  • Dsubsequent encounter for fracture with routine healing
  • Gsubsequent encounter for fracture with delayed healing
  • Ksubsequent encounter for fracture with nonunion
  • Psubsequent encounter for fracture with malunion
  • Ssequela

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name S42, its category, or a range that includes it.

Excludes1 2

These codes carry an Excludes1 note naming S42: they are not reported together with it, unless the two conditions are unrelated.

  • M84.3 Stress fracture
    traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-)
  • M84.4 Pathological fracture, not elsewhere classified
    traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-)

Excludes2 1

These codes carry an Excludes2 note naming S42: its condition is not part of those codes, and both may be reported when the patient has both.

  • S41 Open wound of shoulder and upper arm
    open fracture of shoulder and upper arm (S42.- with 7th character B or C)

Patient EducationClinical

Fractures

A fracture is a break in a bone. Fractures are usually caused by injuries. Since they can sometimes be serious, it's important to get medical care right away if you think you have a fracture.

The full article covers:

  • What is a fracture?
  • What are the different types of fractures?
  • What causes fractures?
  • What are the symptoms of a fracture?
  • How are fractures diagnosed?
  • What are the treatments for fractures?
  • Can fractures be prevented?

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About S42Overview

What is the ICD-10 code for fracture of shoulder and upper arm?

S42 is the ICD-10-CM category for fracture of shoulder and upper arm, but it is a non-billable header: claims need a more specific code from this category, listed on this page.

Is S42 (Fracture of shoulder and upper arm) a billable code?

No. This is a category header that groups the codes for fracture of shoulder and upper arm, and headers cannot be submitted on claims. Claims for fracture of shoulder and upper arm need a more specific code from this category, such as S42.001A, S42.001B, and S42.001D.

Can S42 be reported with a code from S48?

Not as a rule. The Excludes1 note on S42 lists "traumatic amputation of shoulder and upper arm (S48.-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).