S42.115P
S42.115P: Nondisplaced fracture of body of scapula, left shoulder, subsequent encounter for fracture with malunion
Billable / specific codeICD-10-CMPOA exemptleft
S42.115P is a billable, specific ICD-10-CM code for nondisplaced fracture of body of scapula, left shoulder, subsequent encounter for fracture with malunion. It is valid for submission on a claim.
Check S42.115P with the rest of the claim: free scrubber7th character "P": subsequent encounter for fracture with malunion
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 inherited from the categories above S42.115P
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above S42.115P
Not part of this code, but both may be coded when both are present.
Other codes that can never be billed with S42.115P
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
S42.115P is named in 3 Medicare coverage policies: 3 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A53058Billing and Coding: Home Health Physical Therapy
- A53065Billing and Coding: Outpatient Physical Therapy
- A59878Billing and Coding: Total Shoulder Arthroplasty
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S42.115
- S42.115ANondisplaced fracture of body of scapula, left shoulder, initial encounter for closed fracture
- S42.115BNondisplaced fracture of body of scapula, left shoulder, initial encounter for open fracture
- S42.115DNondisplaced fracture of body of scapula, left shoulder, subsequent encounter for fracture with routine healing
- S42.115GNondisplaced fracture of body of scapula, left shoulder, subsequent encounter for fracture with delayed healing
- S42.115KNondisplaced fracture of body of scapula, left shoulder, subsequent encounter for fracture with nonunion
- S42.115SNondisplaced fracture of body of scapula, left shoulder, sequela