S42.294S
S42.294S: Other nondisplaced fracture of upper end of right humerus, sequela
Billable / specific codeICD-10-CMPOA exemptright
S42.294S is a billable, specific ICD-10-CM code for other nondisplaced fracture of upper end of right humerus, sequela. It is valid for submission on a claim.
Check S42.294S with the rest of the claim: free scrubber7th 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 S42.294S
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above S42.294S
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 S42.294S
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
S42.294S is named in 6 Medicare coverage policies: 6 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A53057Billing and Coding: Home Health Occupational Therapy
- A53058Billing and Coding: Home Health Physical Therapy
- A53064Billing and Coding: Outpatient Occupational Therapy
- A53065Billing and Coding: Outpatient Physical Therapy
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S42.294
- S42.294AOther nondisplaced fracture of upper end of right humerus, initial encounter for closed fracture
- S42.294BOther nondisplaced fracture of upper end of right humerus, initial encounter for open fracture
- S42.294DOther nondisplaced fracture of upper end of right humerus, subsequent encounter for fracture with routine healing
- S42.294GOther nondisplaced fracture of upper end of right humerus, subsequent encounter for fracture with delayed healing
- S42.294KOther nondisplaced fracture of upper end of right humerus, subsequent encounter for fracture with nonunion
- S42.294POther nondisplaced fracture of upper end of right humerus, subsequent encounter for fracture with malunion