S42.213
S42.213 — Unspecified displaced fracture of surgical neck of unspecified humerus
Non-billable headerICD-10-CM
S42.213 is a non-billable header ICD-10-CM code for unspecified displaced fracture of surgical neck of unspecified humerus. 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
S42.213 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 S42.213
7 child codes. Green means billable.
- S42.213AUnspecified displaced fracture of surgical neck of unspecified humerus, initial encounter for closed fracture
- S42.213BUnspecified displaced fracture of surgical neck of unspecified humerus, initial encounter for open fracture
- S42.213DUnspecified displaced fracture of surgical neck of unspecified humerus, subsequent encounter for fracture with routine healing
- S42.213GUnspecified displaced fracture of surgical neck of unspecified humerus, subsequent encounter for fracture with delayed healing
- S42.213KUnspecified displaced fracture of surgical neck of unspecified humerus, subsequent encounter for fracture with nonunion
- S42.213PUnspecified displaced fracture of surgical neck of unspecified humerus, subsequent encounter for fracture with malunion
- S42.213SUnspecified displaced fracture of surgical neck of unspecified humerus, sequela
Related codes at this level
Codes that share S42.21. If S42.213 is not quite right, the correct code is usually one of these.
- S42.211Unspecified displaced fracture of surgical neck of right humerus
- S42.212Unspecified displaced fracture of surgical neck of left humerus
- S42.214Unspecified nondisplaced fracture of surgical neck of right humerus
- S42.215Unspecified nondisplaced fracture of surgical neck of left humerus
- S42.216Unspecified nondisplaced fracture of surgical neck of unspecified humerus
Questions about S42.213
- Is S42.213 a billable ICD-10-CM code?
- No. S42.213 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
- Where does S42.213 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).