Is S42 a billable ICD-10-CM code?

No. S42 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does S42 sit in the tabular list?

Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the shoulder and upper arm (S40-S49).

What cannot be coded together with S42?

S42 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

S42

S42 — Fracture of shoulder and upper arm

Non-billable headerICD-10-CM

S42 is a non-billable header ICD-10-CM code for fracture of shoulder and upper arm. It cannot be billed on its own: choose one of the more specific child codes below. This code also requires a 7th character before it is complete.

This code requires a 7th character

The appropriate 7th character is to be added to all codes from category S42

A: initial encounter for closed fracture
B: initial encounter for open fracture
D: subsequent encounter for fracture with routine healing
G: subsequent encounter for fracture with delayed healing
K: subsequent encounter for fracture with nonunion
P: subsequent encounter for fracture with malunion
S: sequela

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

traumatic amputation of shoulder and upper arm (S48.-)

Excludes2 — not included here, but may coexist

The excluded condition is not part of this code, but a patient can have both. You may code both.

periprosthetic fracture around internal prosthetic shoulder joint (M97.3)

Notes

Additional guidance from the ICD-10-CM tabular list.

A fracture not indicated as displaced or nondisplaced should be coded to displaced
A fracture not indicated as open or closed should be coded to closed

Other codes that can never be billed with S42

These codes carry an Excludes1 note pointing at S42. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading S42 alone.

M84.3Stress fracture
M84.4Pathological fracture, not elsewhere classified

Risk adjustment

S42 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code to one of these instead S42

6 child codes. Green means billable.

Questions about S42

Is S42 a billable ICD-10-CM code?: No. S42 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does S42 sit in the tabular list?: Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the shoulder and upper arm (S40-S49).
What cannot be coded together with S42?: S42 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.