S42.311P — Greenstick fracture of shaft of humerus, right arm, subsequent encounter for fracture with malunion
S42.311P is a billable, specific ICD-10-CM code for greenstick fracture of shaft of humerus, right arm, subsequent encounter for fracture with malunion. It is valid for submission on a claim.
7th character "P" — subsequent encounter for fracture with malunion
The appropriate 7th character is to be added to all codes in subcategory S42.31
- A
- initial encounter for closed 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
Risk adjustment
S42.311P 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.
Medicare coverage
S42.311P is named in 2 Medicare coverage policies — 2 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A53058Billing and Coding: Home Health Physical Therapy
- A53065Billing and Coding: Outpatient Physical Therapy
Related codes at this level
Codes that share S42.311. If S42.311P is not quite right, the correct code is usually one of these.
- S42.311AGreenstick fracture of shaft of humerus, right arm, initial encounter for closed fracture
- S42.311DGreenstick fracture of shaft of humerus, right arm, subsequent encounter for fracture with routine healing
- S42.311GGreenstick fracture of shaft of humerus, right arm, subsequent encounter for fracture with delayed healing
- S42.311KGreenstick fracture of shaft of humerus, right arm, subsequent encounter for fracture with nonunion
- S42.311SGreenstick fracture of shaft of humerus, right arm, sequela
Questions about S42.311P
- Is S42.311P a billable ICD-10-CM code?
- Yes. S42.311P is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does S42.311P 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).