Fracture of shoulder and upper arm
In Injuries to the shoulder and upper arm (S40-S49), chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes
1,398 billable codes under S42: 132 are an MCC, 603 are a CC; none map to an HCC.A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment.
Advertisements
Instructional notes
Also applies, from Injuries to the shoulder and upper arm (S40-S49)
These notes sit on S40-S49 and apply to every code under it, including S42.
Official coding guidelines
From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.
- Section I.C.19.c Coding of Traumatic Fractures (page 79), covers S42
Code fractures by site; default to closed and displaced when not specified. Use initial 7th characters during active treatment and subsequent ones during healing, not aftercare Z codes; use M80 for osteoporotic fractures from minor trauma.
Other Chapter 19 topics:
- Application of 7th Characters in Chapter 19 (page 77)
- Coding of Injuries (page 78)
- Coding of Burns and Corrosions (page 80)
- Adverse Effects, Poisoning, Underdosing and Toxic Effects (page 82)
- Adult and child abuse, neglect and other maltreatment (page 85)
- Complications of care (page 85)
Codes under S42
S42 can't be used on a claim. Pick a billable code below; grey headings group them.
S42 MS-DRGs
As the principal diagnosis, the billable codes under S42 group to these 11 MS-DRGs (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.
- DRG 559 Aftercare, Musculoskeletal System and Connective Tissue with MCC (603 of 1398 codes)
- DRG 560 Aftercare, Musculoskeletal System and Connective Tissue with CC (603 of 1398 codes)
- DRG 561 Aftercare, Musculoskeletal System and Connective Tissue without CC/MCC (603 of 1398 codes)
- DRG 564 Other Musculoskeletal System and Connective Tissue Diagnoses with MCC (420 of 1398 codes)
- DRG 565 Other Musculoskeletal System and Connective Tissue Diagnoses with CC (420 of 1398 codes)
- DRG 566 Other Musculoskeletal System and Connective Tissue Diagnoses without CC/MCC (420 of 1398 codes)
- DRG 963 Other Multiple Significant Trauma with MCC (393 of 1398 codes)
- DRG 964 Other Multiple Significant Trauma with CC (393 of 1398 codes)
- DRG 965 Other Multiple Significant Trauma without CC/MCC (393 of 1398 codes)
- DRG 562 Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh with MCC (375 of 1398 codes)
- DRG 563 Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh without MCC (375 of 1398 codes)
Other codes that refer to S42
Notes on these codes point to S42.
About the condition
Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.
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.
Read more about fractures on MedlinePlusShoulder 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.
Read more about shoulder injuries and disorders on MedlinePlusCode history
Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.