S42.213S — Unspecified displaced fracture of surgical neck of unspecified humerus, sequela
Is S42.213S billable?
Yes, but S42.213S is an unspecified code. S42.213S is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, S42.213S 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 S42.213S — the more specific alternatives are listed below.
More specific alternatives
- S42.221S2-part displaced fracture of surgical neck of right humerus, sequela
- S42.231S3-part fracture of surgical neck of right humerus, sequela
- S42.241S4-part fracture of surgical neck of right humerus, sequela
- S42.251SDisplaced fracture of greater tuberosity of right humerus, sequela
- S42.261SDisplaced fracture of lesser tuberosity of right humerus, sequela
- S42.271STorus fracture of upper end of right humerus, sequela
- S42.291SOther displaced fracture of upper end of right humerus, sequela
S42.213S at a glance
| Code | S42.213S |
|---|---|
| Description | Unspecified displaced fracture of surgical neck of unspecified humerus, sequela |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "S" | sequela |
What does the 7th character "S" mean in S42.213S?
In S42.213S, the 7th character S means sequela. The 7th character is required for S42.213S to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
- Ainitial encounter for closed fractureS42.213A
- Binitial encounter for open fractureS42.213B
- Dsubsequent encounter for fracture with routine healingS42.213D
- Gsubsequent encounter for fracture with delayed healingS42.213G
- Ksubsequent encounter for fracture with nonunionS42.213K
- Psubsequent encounter for fracture with malunionS42.213P
- SsequelaS42.213S
Which MS-DRGs does S42.213S group to?
S42.213S 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.
- 559Aftercare, Musculoskeletal System and Connective Tissue with MCCmedical
- 560Aftercare, Musculoskeletal System and Connective Tissue with CCmedical
- 561Aftercare, Musculoskeletal System and Connective Tissue without CC/MCCmedical
How is S42.213S listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S42.21, the nearest indexed parent of S42.213S. Use them to find the family, then select the specific code.
- Fracture, traumatic › humerus › upper end › surgical neck (abduction) (adduction) (separation)
- Fracture, traumatic › humerus › upper end › surgical neck › nondisplaced (abduction) (adduction) (separation)
Excludes1 — never code together — inherited from S42
The conditions below can never be reported together with S42.213S 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 S42.213S to fully describe the condition. S42.213S 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 S42.213S, but a patient may have both at the same time. When documentation supports it, S42.213S and the excluded code may both be reported.
Excludes2 — not included here — inherited from S40-S49
The conditions below are not part of S42.213S, but a patient may have both at the same time. When documentation supports it, S42.213S and the excluded code may both be reported.
Excludes2 — not included here — inherited from S42
The conditions below are not part of S42.213S, but a patient may have both at the same time. When documentation supports it, S42.213S and the excluded code may both be reported.
- periprosthetic fracture around internal prosthetic shoulder joint (M97.3)
Excludes2 — not included here — inherited from S42.2
The conditions below are not part of S42.213S, but a patient may have both at the same time. When documentation supports it, S42.213S and the excluded code may both be reported.
How long has S42.213S existed?
S42.213S 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.