S42.90XD — Fracture of unspecified shoulder girdle, part unspecified, subsequent encounter for fracture with routine healing
Is S42.90XD billable?
Yes, but S42.90XD is an unspecified code. S42.90XD is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, S42.90XD 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 S42.90XD — the more specific alternatives are listed below.
More specific alternatives
- S42.001DFracture of unspecified part of right clavicle, subsequent encounter for fracture with routine healing
- S42.101DFracture of unspecified part of scapula, right shoulder, subsequent encounter for fracture with routine healing
- S42.201DUnspecified fracture of upper end of right humerus, subsequent encounter for fracture with routine healing
- S42.301DUnspecified fracture of shaft of humerus, right arm, subsequent encounter for fracture with routine healing
- S42.401DUnspecified fracture of lower end of right humerus, subsequent encounter for fracture with routine healing
S42.90XD at a glance
| Code | S42.90XD |
|---|---|
| Description | Fracture of unspecified shoulder girdle, part unspecified, 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 S42.90XD?
In S42.90XD, the 7th character D means subsequent encounter for fracture with routine healing. The 7th character is required for S42.90XD to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
- Ainitial encounter for closed fractureS42.90XA
- Binitial encounter for open fractureS42.90XB
- Dsubsequent encounter for fracture with routine healingS42.90XD
- Gsubsequent encounter for fracture with delayed healingS42.90XG
- Ksubsequent encounter for fracture with nonunionS42.90XK
- Psubsequent encounter for fracture with malunionS42.90XP
- SsequelaS42.90XS
Which MS-DRGs does S42.90XD group to?
S42.90XD 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 S42.90XD listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S42.9, the nearest indexed parent of S42.90XD. Use them to find the family, then select the specific code.
- Fracture, traumatic › shoulder (abduction) (adduction) (separation)
Excludes1 — never code together — inherited from S42
The conditions below can never be reported together with S42.90XD 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 S42.90XD to fully describe the condition. S42.90XD 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 S42.90XD, but a patient may have both at the same time. When documentation supports it, S42.90XD and the excluded code may both be reported.
Excludes2 — not included here — inherited from S40-S49
The conditions below are not part of S42.90XD, but a patient may have both at the same time. When documentation supports it, S42.90XD and the excluded code may both be reported.
Excludes2 — not included here — inherited from S42
The conditions below are not part of S42.90XD, but a patient may have both at the same time. When documentation supports it, S42.90XD and the excluded code may both be reported.
- periprosthetic fracture around internal prosthetic shoulder joint (M97.3)
How long has S42.90XD existed?
S42.90XD 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.