Is S42.3 a billable ICD-10-CM code?

No. S42.3 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does S42.3 sit in the tabular list?

Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the shoulder and upper arm (S40-S49).

S42.3

S42.3 — Fracture of shaft of humerus

Non-billable headerICD-10-CM

S42.3 is a non-billable header ICD-10-CM code for fracture of shaft of humerus. It cannot be billed on its own: choose one of the more specific child codes below. This code also requires a 7th character before it is complete.

This code requires a 7th character

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

Excludes2 — not included here, but may coexist

The excluded condition is not part of this code, but a patient can have both. You may code both.

physeal fractures of upper end of humerus (S49.0-)
physeal fractures of lower end of humerus (S49.1-)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Fracture of humerus NOS
Fracture of upper arm NOS

Risk adjustment

S42.3 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code to one of these instead S42.3

8 child codes. Green means billable.

Related codes at this level

Codes that share S42. If S42.3 is not quite right, the correct code is usually one of these.

Questions about S42.3

Is S42.3 a billable ICD-10-CM code?: No. S42.3 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does S42.3 sit in the tabular list?: Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the shoulder and upper arm (S40-S49).