S42.2 vs S49.0
S42.2 (Fracture of upper end of humerus) compared with S49.0 (Physeal fracture of upper end of humerus), from the official CMS tabular data. Both may be reported when both conditions are documented (Excludes2).
Can these codes be reported together?
Yes, when both are documented. S42.2 carries an Excludes2 note covering S49.0: “physeal fracture of upper end of humerus (S49.0-)”
Excludes2 marks distinct conditions — both may be reported when both are documented.
Side by side
| S42.2Fracture of upper end of humerus | S49.0Physeal fracture of upper end of humerus | |
|---|---|---|
| Billing status | Non-billable header Report instead: S42.201A, S42.201B, S42.201D, S42.201G, S42.201K | Non-billable header Report instead: S49.001A, S49.001D, S49.001G, S49.001K, S49.001P |
| 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 | Fracture of upper end of humerus is a non-billable ICD-10-CM category code (S42.2). | Physeal fracture of upper end of humerus is a non-billable ICD-10-CM category code (S49.0). |
| 7th character | The appropriate 7th character is to be added to all codes from category S42 | The appropriate 7th character is to be added to each code from subcategories S49.0 and S49.1 |
| Includes | injuries of axilla injuries of scapular region Fracture of proximal end of humerus | 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