S42.209D: Unspecified fracture of upper end of unspecified humerus, subsequent encounter for fracture with routine healing
S42.209D is a billable, specific ICD-10-CM code for unspecified fracture of upper end of unspecified humerus, subsequent encounter for fracture with routine healing. It is valid for submission on a claim.
Check S42.209D with the rest of the claim: free scrubber7th character "D": subsequent encounter for fracture with routine healing
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 S42.209D
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above S42.209D
Not part of this code, but both may be coded when both are present.
Written on S42.2: Fracture of upper end of humerus
Other codes that can never be billed with S42.209D
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
S42.209D 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 S42.209
- S42.209AUnspecified fracture of upper end of unspecified humerus, initial encounter for closed fracture
- S42.209BUnspecified fracture of upper end of unspecified humerus, initial encounter for open fracture
- S42.209GUnspecified fracture of upper end of unspecified humerus, subsequent encounter for fracture with delayed healing
- S42.209KUnspecified fracture of upper end of unspecified humerus, subsequent encounter for fracture with nonunion
- S42.209PUnspecified fracture of upper end of unspecified humerus, subsequent encounter for fracture with malunion
- S42.209SUnspecified fracture of upper end of unspecified humerus, sequela