Non-Billable / Non-Specific Code
ICD-10-CM S42 is the diagnosis code for Fracture of shoulder and upper arm. This code falls under the section "Injuries to the shoulder and upper arm" within Chapter 19 â Injury, poisoning and certain other consequences of external causes (S00-T88). It is a non-billable/non-specific ICD-10-CM code that should not be used for reimbursement. A more specific sub-code is required for billing. Medical coders and healthcare providers use this code to document and classify diagnoses in electronic health records, insurance claims, and clinical databases.
The following conditions should never be coded at the same time as S42. They are mutually exclusive:
The following conditions are not included in S42. If the patient has both, code each condition separately:
Understanding where S42 sits in the ICD-10-CM classification helps ensure proper coding:
No, S42 is a non-billable/non-specific code. You should use a more specific sub-code for billing and reimbursement.
S42 is the ICD-10-CM diagnosis code for "Fracture of shoulder and upper arm". It is used by healthcare providers to classify and document this condition in medical records and insurance claims.
S42 is located in Section S40-S49 â "Injuries to the shoulder and upper arm" within Chapter 19 of the ICD-10-CM Tabular List.
S42 has 6 sub-code(s) that provide more specific detail: S42.0, S42.1, S42.2, S42.3, S42.4 and more.
Use S42 when the patients documented diagnosis matches "Fracture of shoulder and upper arm" and the clinical documentation supports this level of specificity. Always verify with the latest ICD-10-CM guidelines and payer requirements.
The ICD-10-CM code for Fracture of shoulder and upper arm is S42.
No, S42 is non-billable. Use a more specific sub-code for primary diagnosis billing.
S42 is in Chapter 19 of the ICD-10-CM Tabular List.
Type 1 Excludes for S42 include: traumatic amputation of shoulder and upper arm (S48.-).
Yes, S42 is a valid ICD-10-CM code for the 2026 fiscal year, subject to official CMS updates.