S42.496S
S42.496S: Other nondisplaced fracture of lower end of unspecified humerus, sequela
Billable / specific codeICD-10-CMPOA exempt
S42.496S is a billable, specific ICD-10-CM code for other nondisplaced fracture of lower end of unspecified humerus, sequela. It is valid for submission on a claim.
Check S42.496S with the rest of the claim: free scrubber7th character "S": sequela
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 S42.496S
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above S42.496S
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 S42.496S
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
S42.496S is named in 1 Medicare coverage policy: 1 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A53065Billing and Coding: Outpatient Physical Therapy
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S42.496
- S42.496AOther nondisplaced fracture of lower end of unspecified humerus, initial encounter for closed fracture
- S42.496BOther nondisplaced fracture of lower end of unspecified humerus, initial encounter for open fracture
- S42.496DOther nondisplaced fracture of lower end of unspecified humerus, subsequent encounter for fracture with routine healing
- S42.496GOther nondisplaced fracture of lower end of unspecified humerus, subsequent encounter for fracture with delayed healing
- S42.496KOther nondisplaced fracture of lower end of unspecified humerus, subsequent encounter for fracture with nonunion
- S42.496POther nondisplaced fracture of lower end of unspecified humerus, subsequent encounter for fracture with malunion