S42.295B: Other nondisplaced fracture of upper end of left humerus, initial encounter for open fracture
S42.295B is a billable, specific ICD-10-CM code for other nondisplaced fracture of upper end of left humerus, initial encounter for open fracture. It is valid for submission on a claim.
Check S42.295B with the rest of the claim: free scrubber7th character "B": initial encounter for open fracture
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 S42.295B
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above S42.295B
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 S42.295B
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
S42.295B is named in 5 Medicare coverage policies: 5 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
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- A57311Billing and Coding: Physical Therapy - Home Health
- A58872Billing and Coding: Tetanus Immunization
- A58873Billing and Coding: Tetanus Immunization
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S42.295
- S42.295AOther nondisplaced fracture of upper end of left humerus, initial encounter for closed fracture
- S42.295DOther nondisplaced fracture of upper end of left humerus, subsequent encounter for fracture with routine healing
- S42.295GOther nondisplaced fracture of upper end of left humerus, subsequent encounter for fracture with delayed healing
- S42.295KOther nondisplaced fracture of upper end of left humerus, subsequent encounter for fracture with nonunion
- S42.295POther nondisplaced fracture of upper end of left humerus, subsequent encounter for fracture with malunion
- S42.295SOther nondisplaced fracture of upper end of left humerus, sequela