S42.261K: Displaced fracture of lesser tuberosity of right humerus, subsequent encounter for fracture with nonunion
S42.261K is a billable, specific ICD-10-CM code for displaced fracture of lesser tuberosity of right humerus, subsequent encounter for fracture with nonunion. It is valid for submission on a claim.
Check S42.261K with the rest of the claim: free scrubber7th character "K": subsequent encounter for fracture with nonunion
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 S42.261K
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above S42.261K
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 S42.261K
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
S42.261K is named in 4 Medicare coverage policies: 4 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A53058Billing and Coding: Home Health Physical Therapy
- A53065Billing and Coding: Outpatient Physical Therapy
- A57311Billing and Coding: Physical Therapy - Home Health
- A59878Billing and Coding: Total Shoulder Arthroplasty
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S42.261
- S42.261ADisplaced fracture of lesser tuberosity of right humerus, initial encounter for closed fracture
- S42.261BDisplaced fracture of lesser tuberosity of right humerus, initial encounter for open fracture
- S42.261DDisplaced fracture of lesser tuberosity of right humerus, subsequent encounter for fracture with routine healing
- S42.261GDisplaced fracture of lesser tuberosity of right humerus, subsequent encounter for fracture with delayed healing
- S42.261PDisplaced fracture of lesser tuberosity of right humerus, subsequent encounter for fracture with malunion
- S42.261SDisplaced fracture of lesser tuberosity of right humerus, sequela