S42.199A — Fracture of other part of scapula, unspecified shoulder, initial encounter for closed fracture
Is S42.199A billable?
Yes, but S42.199A is an unspecified code. S42.199A is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, S42.199A is an unspecified or catch-all code. Payers apply additional scrutiny to unspecified codes and many deny them when the medical record supports a more specific option, so check the documentation before selecting S42.199A — the more specific alternatives are listed below.
S42.199A at a glance
| Code | S42.199A |
|---|---|
| Description | Fracture of other part of scapula, unspecified shoulder, initial encounter for closed fracture |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "A" | initial encounter for closed fracture |
What does the 7th character "A" mean in S42.199A?
In S42.199A, the 7th character A means initial encounter for closed fracture. The 7th character is required for S42.199A to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
- Ainitial encounter for closed fractureS42.199A
- Binitial encounter for open fractureS42.199B
- Dsubsequent encounter for fracture with routine healingS42.199D
- Gsubsequent encounter for fracture with delayed healingS42.199G
- Ksubsequent encounter for fracture with nonunionS42.199K
- Psubsequent encounter for fracture with malunionS42.199P
- SsequelaS42.199S
Which MS-DRGs does S42.199A group to?
S42.199A sits in MDC 08 and helps define the logic of 3 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 564Other Musculoskeletal System and Connective Tissue Diagnoses with MCCmedical
- 565Other Musculoskeletal System and Connective Tissue Diagnoses with CCmedical
- 566Other Musculoskeletal System and Connective Tissue Diagnoses without CC/MCCmedical
How is S42.199A listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S42.19, the nearest indexed parent of S42.199A. Use them to find the family, then select the specific code.
- Fracture, traumatic › scapula › specified NEC (abduction) (adduction) (separation)
Excludes1 — never code together — inherited from S42
The conditions below can never be reported together with S42.199A on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- traumatic amputation of shoulder and upper arm (S48.-)
Use additional code — inherited from Chapter 19
Report an additional code alongside S42.199A to fully describe the condition. S42.199A is sequenced first.
- code to identify any retained foreign body, if applicable (Z18.-)
Excludes2 — not included here — inherited from Chapter 19
The conditions below are not part of S42.199A, but a patient may have both at the same time. When documentation supports it, S42.199A and the excluded code may both be reported.
Excludes2 — not included here — inherited from S40-S49
The conditions below are not part of S42.199A, but a patient may have both at the same time. When documentation supports it, S42.199A and the excluded code may both be reported.
Excludes2 — not included here — inherited from S42
The conditions below are not part of S42.199A, but a patient may have both at the same time. When documentation supports it, S42.199A and the excluded code may both be reported.
- periprosthetic fracture around internal prosthetic shoulder joint (M97.3)
How long has S42.199A existed?
S42.199A has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.