S41.13 (Puncture wound without foreign body of upper arm) compared with S42 (Fracture of shoulder and upper arm), from the official CMS tabular data. Both may be reported when both conditions are documented (Excludes2).
Distinct conditions — both may be reported.
“open fracture of shoulder and upper arm (S42.- with 7th character B or C)”
An Excludes2 note means the excluded condition is not part of the code above it, but a patient can have both. Report both when both are documented.
Source: CMS ICD-10-CM tabular instructional notes
Yes, when both are documented. S41.13 carries an Excludes2 note covering S42: “open fracture of shoulder and upper arm (S42.- with 7th character B or C)”
Excludes2 marks distinct conditions — both may be reported when both are documented.
| S41.13Puncture wound without foreign body of upper arm | S42Fracture of shoulder and upper arm | |
|---|---|---|
| Billing status | Non-billable header | Non-billable header Report instead: S42.001A, S42.001B, S42.001D, S42.001G, S42.001K |
| Classification | S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) | S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) |
| Definition | Puncture wound without foreign body of upper arm is a non-billable ICD-10-CM category code (S41.13). | Fracture of shoulder and upper arm is a non-billable ICD-10-CM category code (S42). |
| 7th character | The appropriate 7th character is to be added to each code from category S41 | The appropriate 7th character is to be added to all codes from category S42 |
| Includes | injuries of axilla injuries of scapular region | injuries of axilla injuries of scapular region |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources