S42 vs S42.001A
S42 (Fracture of shoulder and upper arm) compared with S42.001A (Fracture of unspecified part of right clavicle, initial encounter for closed fracture), from the official CMS tabular data.
Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources
Summary
These codes represent different levels of the same hierarchy: S42 is the non-billable header that contains S42.001A, so only S42.001A (or a sibling) is reported.
Registry fact- What is different?
Title wording and billing status.The titles share “Fracture of”; S42 says “shoulder and upper arm” where S42.001A says “unspecified part of right clavicle, initial encounter for closed fracture”. S42 is a non-billable header; S42.001A is billable.
Registry fact
- Can these codes be reported together?
Not as a pair.S42 is the non-billable header that contains S42.001A. A header is not reported on a claim, so the choice is S42.001A or a sibling that matches the documentation.
Registry fact
- Is one more specific?
Yes.S42.001A is a subdivision of S42 in the tabular hierarchy, so it is the more specific of the two.
Registry fact
- Is one a parent or header code?
Yes.S42 is the non-billable header that contains S42.001A. A header stands for the whole family beneath it and is not reported on a claim.
Registry fact
Nothing found in 4 other checks
- Is there an Excludes1 relationship?
None.Neither entry carries an Excludes1 note that names the other code. S42 carries 1 Excludes1 note and S42.001A carries 1 Excludes1 note covering other codes; the side-by-side table quotes them.
Official rule
- Is there an Excludes2 relationship?
None.Neither entry carries an Excludes2 note that names the other code. S42 carries 5 Excludes2 notes and S42.001A carries 5 Excludes2 notes covering other codes; the side-by-side table quotes them.
Official rule
- Are there sequencing instructions?
None.Neither entry carries a Code First or Use Additional Code note that names the other.
Official rule
- Are there other coding relationships?
None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.
MedCoder-derived
Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels
Can these codes be reported together?
Not as a pair — S42 is not reportable. S42 is the non-billable category that contains S42.001A.
A header stands for the whole family of codes beneath it and is not reported on a claim, so the choice is S42.001A or a sibling that matches the documentation. No Excludes1/Excludes2 relationship exists between these codes in the official tabular list.
Official guidance behind these answers
Section I.B.2 — Level of Detail in Coding · applies to: S42 and S42.001A
Diagnosis codes are to be used and reported at their highest number of characters available and to the highest level of specificity documented in the medical record. ICD-10-CM diagnosis codes are composed of codes with 3, 4, 5, 6 or 7 characters. Codes with three characters are included in ICD-10-CM as the heading of a category of codes that may be further subdivided by the use of fourth and/or fifth characters and/or sixth characters, which provide greater detail. A three-character code is to be used only if it is not further subdivided. A code is invalid if it has not been coded to the full number of characters required for that code, including the 7th character, if applicable.
ICD-10-CM Official Guidelines FY2027
Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum
Side by side
Similar descriptions do not make codes interchangeable. The documentation and the official instructions decide which code applies.
Fracture of shoulder and upper arm
Fracture of unspecified part of right clavicle, initial encounter for closed fracture
- traumatic amputation of shoulder and upper arm (S48.-)
- periprosthetic fracture around internal prosthetic shoulder joint (M97.3)
- burns and corrosions (T20-T32)
- frostbite (T33-T34)
- injuries of elbow (S50-S59)
- insect bite or sting, venomous (T63.4)
S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88)
- injuries of axilla
- injuries of scapular region
- The appropriate 7th character is to be added to all codes from category S42
No Code first, Use additional code and Code also note at either code.
Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on. In a row that differs, each code’s own notes are listed under it, and the notes every code shares are listed once beneath them.
Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources