S42.461P: Displaced fracture of medial condyle of right humerus, subsequent encounter for fracture with malunion
S42.461P is a billable, specific ICD-10-CM code for displaced fracture of medial condyle of right humerus, subsequent encounter for fracture with malunion. It is valid for submission on a claim.
Check S42.461P with the rest of the claim: free scrubber7th character "P": subsequent encounter for fracture with malunion
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 S42.461P
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above S42.461P
Not part of this code, but both may be coded when both are present.
Written on S42.4: Fracture of lower end of humerus
Other codes that can never be billed with S42.461P
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
S42.461P is named in 2 Medicare coverage policies: 2 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A53058Billing and Coding: Home Health Physical Therapy
- A53065Billing and Coding: Outpatient Physical Therapy
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S42.461
- S42.461ADisplaced fracture of medial condyle of right humerus, initial encounter for closed fracture
- S42.461BDisplaced fracture of medial condyle of right humerus, initial encounter for open fracture
- S42.461DDisplaced fracture of medial condyle of right humerus, subsequent encounter for fracture with routine healing
- S42.461GDisplaced fracture of medial condyle of right humerus, subsequent encounter for fracture with delayed healing
- S42.461KDisplaced fracture of medial condyle of right humerus, subsequent encounter for fracture with nonunion
- S42.461SDisplaced fracture of medial condyle of right humerus, sequela