S42.215A: Unspecified nondisplaced fracture of surgical neck of left humerus, initial encounter for closed fracture
S42.215A is a billable, specific ICD-10-CM code for unspecified nondisplaced fracture of surgical neck of left humerus, initial encounter for closed fracture. It is valid for submission on a claim.
Check S42.215A with the rest of the claim: free scrubber7th 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
Excludes1 inherited from the categories above S42.215A
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above S42.215A
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 S42.215A
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
S42.215A is named in 1 Medicare coverage policy: 1 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A59878Billing and Coding: Total Shoulder Arthroplasty
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S42.215
- S42.215BUnspecified nondisplaced fracture of surgical neck of left humerus, initial encounter for open fracture
- S42.215DUnspecified nondisplaced fracture of surgical neck of left humerus, subsequent encounter for fracture with routine healing
- S42.215GUnspecified nondisplaced fracture of surgical neck of left humerus, subsequent encounter for fracture with delayed healing
- S42.215KUnspecified nondisplaced fracture of surgical neck of left humerus, subsequent encounter for fracture with nonunion
- S42.215PUnspecified nondisplaced fracture of surgical neck of left humerus, subsequent encounter for fracture with malunion
- S42.215SUnspecified nondisplaced fracture of surgical neck of left humerus, sequela