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S42.212 vs S42.213

S42.212 (Unspecified displaced fracture of surgical neck of left humerus) compared with S42.213 (Unspecified displaced fracture of surgical neck of unspecified humerus), from the official CMS tabular data. S42.212 and S42.213 code the same condition on opposite sides. MedCoder-derived

Relationship

Review

Laterality relationship

S42.212
Left
Unspecified displaced fracture of surgical neck of left humerus
S42.213
Unspecified
Unspecified displaced fracture of surgical neck of unspecified humerus

Same condition; these differ only in which side is documented.

These codes share a category and title and differ only in the side affected. The documentation decides which applies, and a bilateral code is reported only where the code set provides one.

Source: ICD-10-CM tabular list (laterality variant derived from the code title)

Can these codes be reported together?

Same condition, opposite side. S42.212 and S42.213 name the same condition on opposite sides of the body.

Same category and title, differing only in which side is affected — the documentation decides which one applies, and a bilateral code is reported only where the code set provides one.

Side by side

S42.212Unspecified displaced fracture of surgical neck of left humerusS42.213Unspecified displaced fracture of surgical neck of unspecified humerus
Billing statusNon-billable header

Report instead: S42.212A, S42.212B, S42.212D, S42.212G, S42.212K

Non-billable header

Report instead: S42.213A, S42.213B, S42.213D, S42.213G, S42.213K

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 displaced fracture of surgical neck of left humerus is a non-billable ICD-10-CM category code (S42.212).Unspecified displaced fracture of surgical neck of unspecified humerus is a non-billable ICD-10-CM category code (S42.213).
7th characterThe appropriate 7th character is to be added to all codes from category S42The 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