S42.256S

S42.256S: Nondisplaced fracture of greater tuberosity of unspecified humerus, sequela

Billable / specific codeICD-10-CMPOA exempt

S42.256S is a billable, specific ICD-10-CM code for nondisplaced fracture of greater tuberosity of unspecified humerus, sequela. It is valid for submission on a claim.

Check S42.256S with the rest of the claim: free scrubber

7th character "S": sequela

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 S42.256S

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 S42.256S

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 S42.256S

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.

Medicare coverage

S42.256S 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.