S42.402P — Unspecified fracture of lower end of left humerus, subsequent encounter for fracture with malunion
Is S42.402P billable?
Yes, but S42.402P is an unspecified code. S42.402P is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, S42.402P 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 S42.402P — the more specific alternatives are listed below.
More specific alternatives
- S42.411PDisplaced simple supracondylar fracture without intercondylar fracture of right humerus, subsequent encounter for fracture with malunion
- S42.421PDisplaced comminuted supracondylar fracture without intercondylar fracture of right humerus, subsequent encounter for fracture with malunion
- S42.431PDisplaced fracture (avulsion) of lateral epicondyle of right humerus, subsequent encounter for fracture with malunion
- S42.441PDisplaced fracture (avulsion) of medial epicondyle of right humerus, subsequent encounter for fracture with malunion
- S42.451PDisplaced fracture of lateral condyle of right humerus, subsequent encounter for fracture with malunion
- S42.461PDisplaced fracture of medial condyle of right humerus, subsequent encounter for fracture with malunion
- S42.471PDisplaced transcondylar fracture of right humerus, subsequent encounter for fracture with malunion
- S42.481PTorus fracture of lower end of right humerus, subsequent encounter for fracture with malunion
- S42.491POther displaced fracture of lower end of right humerus, subsequent encounter for fracture with malunion
S42.402P at a glance
| Code | S42.402P |
|---|---|
| Description | Unspecified fracture of lower end of left humerus, subsequent encounter for fracture with malunion |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "P" | subsequent encounter for fracture with malunion |
What does the 7th character "P" mean in S42.402P?
In S42.402P, the 7th character P means subsequent encounter for fracture with malunion. The 7th character is required for S42.402P to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
- Ainitial encounter for closed fractureS42.402A
- Binitial encounter for open fractureS42.402B
- Dsubsequent encounter for fracture with routine healingS42.402D
- Gsubsequent encounter for fracture with delayed healingS42.402G
- Ksubsequent encounter for fracture with nonunionS42.402K
- Psubsequent encounter for fracture with malunionS42.402P
- SsequelaS42.402S
Which MS-DRGs does S42.402P group to?
S42.402P 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
As a secondary diagnosis, S42.402P is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is S42.402P listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S42.40, the nearest indexed parent of S42.402P. Use them to find the family, then select the specific code.
- Fracture, traumatic › elbow (abduction) (adduction) (separation)
- Fracture, traumatic › humerus › lower end (abduction) (adduction) (separation)
Excludes1 — never code together — inherited from S42
The conditions below can never be reported together with S42.402P 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 S42.402P to fully describe the condition. S42.402P 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 S42.402P, but a patient may have both at the same time. When documentation supports it, S42.402P and the excluded code may both be reported.
Excludes2 — not included here — inherited from S40-S49
The conditions below are not part of S42.402P, but a patient may have both at the same time. When documentation supports it, S42.402P and the excluded code may both be reported.
Excludes2 — not included here — inherited from S42
The conditions below are not part of S42.402P, but a patient may have both at the same time. When documentation supports it, S42.402P and the excluded code may both be reported.
- periprosthetic fracture around internal prosthetic shoulder joint (M97.3)
Excludes2 — not included here — inherited from S42.4
The conditions below are not part of S42.402P, but a patient may have both at the same time. When documentation supports it, S42.402P and the excluded code may both be reported.
How long has S42.402P existed?
S42.402P 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.