Is S42.116 a billable ICD-10-CM code?

No. S42.116 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does S42.116 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).

S42.116

S42.116 — Nondisplaced fracture of body of scapula, unspecified shoulder

Non-billable headerICD-10-CMunspecified

S42.116 is a non-billable header ICD-10-CM code for nondisplaced fracture of body of scapula, unspecified shoulder. 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

Risk adjustment

S42.116 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 S42.116

7 child codes. Green means billable.

Related codes at this level

Codes that share S42.11. If S42.116 is not quite right, the correct code is usually one of these.

Questions about S42.116

Is S42.116 a billable ICD-10-CM code?: No. S42.116 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does S42.116 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).