S42.292D: Other displaced fracture of upper end of left humerus, subsequent encounter for fracture with routine healing
S42.292D is a billable, specific ICD-10-CM code for other displaced fracture of upper end of left humerus, subsequent encounter for fracture with routine healing. It is valid for submission on a claim.
Check S42.292D with the rest of the claim: free scrubber7th character "D": subsequent encounter for fracture with routine healing
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 S42.292D
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above S42.292D
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 S42.292D
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
S42.292D 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 S42.292
- S42.292AOther displaced fracture of upper end of left humerus, initial encounter for closed fracture
- S42.292BOther displaced fracture of upper end of left humerus, initial encounter for open fracture
- S42.292GOther displaced fracture of upper end of left humerus, subsequent encounter for fracture with delayed healing
- S42.292KOther displaced fracture of upper end of left humerus, subsequent encounter for fracture with nonunion
- S42.292POther displaced fracture of upper end of left humerus, subsequent encounter for fracture with malunion
- S42.292SOther displaced fracture of upper end of left humerus, sequela