2026 ICD-10-CM Diagnosis Code S42.301GUnspecified fracture of shaft of humerus, right arm, subsequent encounter for fracture with delayed healing
S42.301G is a billable ICD-10-CM diagnosis code for unspecified fracture of shaft of humerus, right arm, subsequent encounter for fracture with delayed healing. The 7th character G reports a subsequent encounter for a fracture that is healing more slowly than expected. 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. 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
S42.301G 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 humerus
- Closed fracture of shaft of humerus
- Closed fracture of shaft of right humerus
- Fracture of shaft of humerus
- Fracture of shaft of right humerus
- Open fracture of right humerus
- Open fracture of shaft of humerus
- Open fracture of shaft of right humerus
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
Arm Injuries and Disorders
Of the 206 bones in your body, three of them are in your arm: the humerus, radius, and ulna. Your arms are also made up of muscles, joints, tendons, and other connective tissue. Injuries to any of these parts of the arm can occur during sports, a fall, or an accident.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert S42.301G to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About S42.301GOverview
Is S42.301G (Unspecified fracture of shaft of humerus, right arm) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report unspecified fracture of shaft of humerus, right arm, subsequent encounter for fracture with delayed healing on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What does the 7th character G in S42.301G mean?
The final character G reports a subsequent encounter where the unspecified fracture of shaft of humerus, right arm is healing more slowly than expected.
What MS-DRG does S42.301G group to?
When unspecified fracture of shaft of humerus, right arm, subsequent encounter for fracture with delayed 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 S42.301G 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 unspecified fracture of shaft of humerus, right arm, subsequent encounter for fracture with delayed healing on inpatient claims.
What is the ICD-9 equivalent of S42.301G?
Under the General Equivalence Mappings, unspecified fracture of shaft of humerus, right arm, subsequent encounter for fracture with delayed healing converts to ICD-9-CM V54.11 (aftrcare traum fx up arm). 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.
