S42

Header — not billable

Fracture of shoulder and upper arm

The ICD-10 code for fracture of shoulder and upper arm is S42.

S42 is a non-billable header code. It groups related conditions but cannot be used on its own for reimbursement — select one of the 6 more specific codes below.

Clinical notes

Excludes1 (not coded here)

An Excludes1 note is a pure exclusion: the excluded condition and this code should never be reported together, because the two conditions cannot occur at the same time (e.g. a congenital form vs. an acquired form of the same disease).

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

Excludes2 (not included here)

An Excludes2 note means the excluded condition is not part of this one, but a patient can have both at the same time — in that case both codes may be reported together.

periprosthetic fracture around internal prosthetic shoulder joint (M97.3)

7th character definitions

These definitions specify what each valid 7th-character value means for codes in this category.

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7th character note

This category requires a 7th character to indicate additional clinical detail (e.g. encounter type: initial, subsequent, sequela). The code is incomplete without it.

The appropriate 7th character is to be added to all codes from category S42

Documentation support

General coding-documentation guidance — not a substitute for payer-specific requirements or professional coding judgment.

•This is a non-billable header code. Documentation must support a more specific child code before this diagnosis can be reported on a claim.
•Confirm the excluded condition(s) listed above are not also present — Excludes1 conditions cannot be coded together with this one.
•This category requires a 7th character. Documentation should clearly indicate the episode of care (initial encounter, subsequent encounter, or sequela).
•As a general rule, code to the highest level of specificity supported by the documentation in the medical record.

S42