S42.199S
S42.199S: Fracture of other part of scapula, unspecified shoulder, sequela
Billable / specific codeICD-10-CMPOA exemptunspecified
S42.199S is a billable, specific ICD-10-CM code for fracture of other part of scapula, unspecified shoulder, sequela. It is valid for submission on a claim.
Check S42.199S with the rest of the claim: free scrubber7th character "S": sequela
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 S42.199S
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above S42.199S
Not part of this code, but both may be coded when both are present.
Other codes that can never be billed with S42.199S
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
S42.199S is named in 1 Medicare coverage policy: 1 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A53065Billing and Coding: Outpatient Physical Therapy
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S42.199
- S42.199AFracture of other part of scapula, unspecified shoulder, initial encounter for closed fracture
- S42.199BFracture of other part of scapula, unspecified shoulder, initial encounter for open fracture
- S42.199DFracture of other part of scapula, unspecified shoulder, subsequent encounter for fracture with routine healing
- S42.199GFracture of other part of scapula, unspecified shoulder, subsequent encounter for fracture with delayed healing
- S42.199KFracture of other part of scapula, unspecified shoulder, subsequent encounter for fracture with nonunion
- S42.199PFracture of other part of scapula, unspecified shoulder, subsequent encounter for fracture with malunion