S42.216B

S42.216B: Unspecified nondisplaced fracture of surgical neck of unspecified humerus, initial encounter for open fracture

Billable / specific codeICD-10-CM

S42.216B is a billable, specific ICD-10-CM code for unspecified nondisplaced fracture of surgical neck of unspecified humerus, initial encounter for open fracture. It is valid for submission on a claim.

Check S42.216B with the rest of the claim: free scrubber

7th character "B": initial encounter for open 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 S42.216B

A category’s note binds every code beneath it.

Written on S42: Fracture of shoulder and upper arm

traumatic amputation of shoulder and upper arm (S48.-)

Excludes2 inherited from the categories above S42.216B

Not part of this code, but both may be coded when both are present.

Written on S42.2: Fracture of upper end of humerus

fracture of shaft of humerus (S42.3-)
physeal fracture of upper end of humerus (S49.0-)

Written on S42: Fracture of shoulder and upper arm

periprosthetic fracture around internal prosthetic shoulder joint (M97.3)

Other codes that can never be billed with S42.216B

Their own Excludes1 notes name this code, so the conflict is not listed above.

M84.3Stress fracture
M84.4Pathological fracture, not elsewhere classified

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Code history

Unchanged in every release from FY2024 to FY2027.