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

Yes. S42.116A is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does S42.116A 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).

S42.116A

S42.116A — Nondisplaced fracture of body of scapula, unspecified shoulder, initial encounter for closed fracture

Billable / specific codeICD-10-CMunspecified

S42.116A is a billable, specific ICD-10-CM code for nondisplaced fracture of body of scapula, unspecified shoulder, initial encounter for closed fracture. It is valid for submission on a claim.

7th character "A" — initial encounter for closed fracture

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

S42.116A 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.

Related codes at this level

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

Questions about S42.116A

Is S42.116A a billable ICD-10-CM code?: Yes. S42.116A is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does S42.116A 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).