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S42.20 vs S48

S42.20 (Unspecified fracture of upper end of humerus) compared with S48 (Traumatic amputation of shoulder and upper arm), from the official CMS tabular data.

Summary

These codes should not be reported together because S42.20’s tabular entry lists S48 under Excludes1.

Official rule
What is different?

The conditions named.S42.20 is “Unspecified fracture of upper end of humerus”; S48 is “Traumatic amputation of shoulder and upper arm”.

Registry fact

Can these codes be reported together?

No.S42.20’s entry carries an Excludes1 note covering S48: “traumatic amputation of shoulder and upper arm (S48.-)”. Both may be reported only when the documentation shows the two conditions are unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

Yes.S42.20’s tabular entry: “traumatic amputation of shoulder and upper arm (S48.-)”. The note covers S48.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes2 relationship?

None.Neither entry carries an Excludes2 note that names the other code. S42.20 carries 7 Excludes2 notes and S48 carries 4 Excludes2 notes covering other codes; the side-by-side table quotes them.

Official rule

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Is one a parent or header code?

Both are headers.Both are non-billable headers, and neither contains the other.

Registry fact

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?

Conflict

Excludes1 conflict

S42.20
Unspecified fracture of upper end of humerus
↔
S48
Traumatic amputation of shoulder and upper arm

What we found

No — do not report together.S42.20 carries an Excludes1 note covering S48: “traumatic amputation of shoulder and upper arm (S48.-)”

Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

What to review

Report one of the two. Both may be reported only when the documentation shows the two conditions are unrelated to each other.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes1 note means the two conditions cannot occur together, so the pair should not be reported for the same encounter. The sole exception is when the conditions are documented as unrelated to each other.

Source / rule

CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a

Official guidance behind these answers

  • Section I.A.12.a — Excludes1 · applies to: Excludes1

    A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for "sleep related teeth grinding (G47.63)," because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together.

    ICD-10-CM Official Guidelines FY2026

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

S42.20Unspecified fracture of upper end of humerusS48Traumatic amputation of shoulder and upper arm
Billing statusNon-billable header

Report instead: S42.201A, S42.201B, S42.201D, S42.201G, S42.201K

Non-billable header

Report instead: S48.011A, S48.011D, S48.011S, S48.012A, S48.012D

ClassificationS00-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)
DefinitionUnspecified fracture of upper end of humerus is a non-billable ICD-10-CM category code (S42.20).Traumatic amputation of shoulder and upper arm is a non-billable ICD-10-CM category code (S48).
7th characterThe appropriate 7th character is to be added to all codes from category S42The appropriate 7th character is to be added to each code from category S48
Includes
injuries of axilla
injuries of scapular region
injuries of axilla
injuries of scapular region
An amputation not identified as partial or complete should be coded to complete
Excludes1
traumatic amputation of shoulder and upper arm (S48.-)
traumatic amputation at elbow level (S58.0)
Excludes2
fracture of shaft of humerus (S42.3-)
physeal fracture of upper end of humerus (S49.0-)
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)
burns and corrosions (T20-T32)
frostbite (T33-T34)
injuries of elbow (S50-S59)
insect bite or sting, venomous (T63.4)

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.

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Derived from the official CMS ICD-10-CM tabular data (FY2026). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources