S42.463D — Displaced fracture of medial condyle of unspecified humerus, subsequent encounter for fracture with routine healing
Is S42.463D billable?
Yes, but S42.463D is an unspecified code. S42.463D is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, S42.463D 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 S42.463D — the more specific alternatives are listed below.
More specific alternatives
- S42.461DDisplaced fracture of medial condyle of right humerus, subsequent encounter for fracture with routine healing
- S42.462DDisplaced fracture of medial condyle of left humerus, subsequent encounter for fracture with routine healing
- S42.464DNondisplaced fracture of medial condyle of right humerus, subsequent encounter for fracture with routine healing
- S42.465DNondisplaced fracture of medial condyle of left humerus, subsequent encounter for fracture with routine healing
S42.463D at a glance
| Code | S42.463D |
|---|---|
| Description | Displaced fracture of medial condyle of unspecified humerus, subsequent encounter for fracture with routine healing |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "D" | subsequent encounter for fracture with routine healing |
What does the 7th character "D" mean in S42.463D?
In S42.463D, the 7th character D means subsequent encounter for fracture with routine healing. The 7th character is required for S42.463D to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
- Ainitial encounter for closed fractureS42.463A
- Binitial encounter for open fractureS42.463B
- Dsubsequent encounter for fracture with routine healingS42.463D
- Gsubsequent encounter for fracture with delayed healingS42.463G
- Ksubsequent encounter for fracture with nonunionS42.463K
- Psubsequent encounter for fracture with malunionS42.463P
- SsequelaS42.463S
Which MS-DRGs does S42.463D group to?
S42.463D 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 S42.463D listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S42.46, the nearest indexed parent of S42.463D. Use them to find the family, then select the specific code.
- Fracture, traumatic › humerus › lower end › condyle › medial (abduction) (adduction) (separation)
- Fracture, traumatic › humerus › lower end › condyle › medial › nondisplaced (abduction) (adduction) (separation)
Excludes1 — never code together — inherited from S42
The conditions below can never be reported together with S42.463D 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 S42.463D to fully describe the condition. S42.463D 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 S42.463D, but a patient may have both at the same time. When documentation supports it, S42.463D and the excluded code may both be reported.
Excludes2 — not included here — inherited from S40-S49
The conditions below are not part of S42.463D, but a patient may have both at the same time. When documentation supports it, S42.463D and the excluded code may both be reported.
Excludes2 — not included here — inherited from S42
The conditions below are not part of S42.463D, but a patient may have both at the same time. When documentation supports it, S42.463D 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 S42.463D, but a patient may have both at the same time. When documentation supports it, S42.463D and the excluded code may both be reported.
How long has S42.463D existed?
S42.463D 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.