S42.351K — Displaced comminuted fracture of shaft of humerus, right arm, subsequent encounter for fracture with nonunion
S42.351K is a billable, specific ICD-10-CM code for displaced comminuted fracture of shaft of humerus, right arm, subsequent encounter for fracture with nonunion. It is valid for submission on a claim.
7th character "K" — subsequent encounter for fracture with nonunion
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 S42.351K
These are not written on S42.351K, but they bind it: a note on a category applies to every code beneath it. Billing S42.351K with anything listed here is a denial.
Excludes2 inherited from the categories above S42.351K
Also inherited, and the opposite of Excludes1: these conditions are not part of S42.351K, but a patient can have both, so you may code both.
Written on S42.3 — Fracture of shaft of humerus
Other codes that can never be billed with S42.351K
These codes carry an Excludes1 note pointing at S42.351K. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading S42.351K alone.
Risk adjustment
S42.351K 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
S42.351K is named in 3 Medicare coverage policies — 3 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
- A57311Billing and Coding: Physical Therapy - Home Health
Code history
S42.351K has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
Related codes at this level
Codes that share S42.351. If S42.351K is not quite right, the correct code is usually one of these.
- S42.351ADisplaced comminuted fracture of shaft of humerus, right arm, initial encounter for closed fracture
- S42.351BDisplaced comminuted fracture of shaft of humerus, right arm, initial encounter for open fracture
- S42.351DDisplaced comminuted fracture of shaft of humerus, right arm, subsequent encounter for fracture with routine healing
- S42.351GDisplaced comminuted fracture of shaft of humerus, right arm, subsequent encounter for fracture with delayed healing
- S42.351PDisplaced comminuted fracture of shaft of humerus, right arm, subsequent encounter for fracture with malunion
- S42.351SDisplaced comminuted fracture of shaft of humerus, right arm, sequela
Questions about S42.351K
- Is S42.351K a billable ICD-10-CM code?
- Yes. S42.351K is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does S42.351K 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).
- What cannot be coded together with S42.351K?
- S42.351K carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above S42.351K (S42) and apply to it just the same.