S42.4 — Fracture of lower end of humerus
S42.4 is a non-billable header ICD-10-CM code for fracture of lower end 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.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Fracture of distal end of humerus
Risk adjustment
S42.4 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 S42.4
10 child codes. Green means billable.
- S42.40Unspecified fracture of lower end of humerus
- S42.41Simple supracondylar fracture without intercondylar fracture of humerus
- S42.42Comminuted supracondylar fracture without intercondylar fracture of humerus
- S42.43Fracture (avulsion) of lateral epicondyle of humerus
- S42.44Fracture (avulsion) of medial epicondyle of humerus
- S42.45Fracture of lateral condyle of humerus
- S42.46Fracture of medial condyle of humerus
- S42.47Transcondylar fracture of humerus
- S42.48Torus fracture of lower end of humerus
- S42.49Other fracture of lower end of humerus
Related codes at this level
Codes that share S42. If S42.4 is not quite right, the correct code is usually one of these.
Questions about S42.4
- Is S42.4 a billable ICD-10-CM code?
- No. S42.4 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
- Where does S42.4 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).