S42.251P — Displaced fracture of greater tuberosity of right humerus, subsequent encounter for fracture with malunion
S42.251P is a billable, specific ICD-10-CM code for displaced fracture of greater tuberosity of right humerus, subsequent encounter for fracture with malunion. It is valid for submission on a claim.
7th character "P" — subsequent encounter for fracture with malunion
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
S42.251P 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.
Medicare coverage
S42.251P is named in 3 Medicare coverage policies — 3 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A53058Billing and Coding: Home Health Physical Therapy
- A53065Billing and Coding: Outpatient Physical Therapy
- A59878Billing and Coding: Total Shoulder Arthroplasty
Related codes at this level
Codes that share S42.251. If S42.251P is not quite right, the correct code is usually one of these.
- S42.251ADisplaced fracture of greater tuberosity of right humerus, initial encounter for closed fracture
- S42.251BDisplaced fracture of greater tuberosity of right humerus, initial encounter for open fracture
- S42.251DDisplaced fracture of greater tuberosity of right humerus, subsequent encounter for fracture with routine healing
- S42.251GDisplaced fracture of greater tuberosity of right humerus, subsequent encounter for fracture with delayed healing
- S42.251KDisplaced fracture of greater tuberosity of right humerus, subsequent encounter for fracture with nonunion
- S42.251SDisplaced fracture of greater tuberosity of right humerus, sequela
Questions about S42.251P
- Is S42.251P a billable ICD-10-CM code?
- Yes. S42.251P is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does S42.251P 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).