2026 ICD-10-CM Diagnosis Code S42.001DFracture of unspecified part of right clavicle, subsequent encounter for fracture with routine healing
S42.001D is a billable ICD-10-CM diagnosis code for fracture of unspecified part of right clavicle, subsequent encounter for fracture with routine healing. The 7th character D marks it as a subsequent encounter code, used during routine care in the healing or recovery phase. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 559 through 561. The code is exempt from POA reporting. Coders also document this condition as closed fracture of right clavicle. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Fracture of the upper limb, subsequent encounter.
Code Identity
Code Classification
Present on Admission (POA)Billing
S42.001D is exempt from POA reporting on inpatient claims to general acute care hospitals. Review other POA exempt codes.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Closed fracture of right clavicle
- Closed fracture of right shoulder
- Fracture of bone of bilateral clavicles
- Fracture of right clavicle
- Open fracture of clavicle
- Open fracture of right clavicle
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 2026, published by CMS and the National Center for Health Statistics.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
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.
Convert S42.001D to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About S42.001DOverview
Is S42.001D (Fracture of unspecified part of right clavicle) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report fracture of unspecified part of right clavicle, subsequent encounter for fracture with routine healing on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What does the 7th character D in S42.001D mean?
The final character D marks a subsequent encounter: use it for routine care while the fracture of unspecified part of right clavicle is healing, after active treatment has ended.
What MS-DRG does S42.001D group to?
When fracture of unspecified part of right clavicle, subsequent encounter for fracture with routine healing is the principal diagnosis on an inpatient stay, it groups to MS-DRG 559, 560, 561, with relative weights from 0.8039 to 1.8649 depending on complications. Higher weights mean higher Medicare reimbursement.
Is S42.001D exempt from POA reporting?
Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for fracture of unspecified part of right clavicle, subsequent encounter for fracture with routine healing on inpatient claims.
What is the ICD-9 equivalent of S42.001D?
Under the General Equivalence Mappings, fracture of unspecified part of right clavicle, subsequent encounter for fracture with routine healing converts to ICD-9-CM V54.19 (aftrce traum fx bone NEC). The mapping is approximate, so confirm the match fits the documentation.
Footnotes
[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.
