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S42.225D vs S42.226D

S42.225D (2-part nondisplaced fracture of surgical neck of left humerus, subsequent encounter for fracture with routine healing) compared with S42.226D (2-part nondisplaced fracture of surgical neck of unspecified humerus, subsequent encounter for fracture with routine healing), from the official CMS tabular data. S42.225D and S42.226D code the same condition on opposite sides. MedCoder-derived

Relationship

Review

Laterality relationship

S42.225D
Left
2-part nondisplaced fracture of surgical neck of left humerus, subsequent encounter for fracture with routine healing
↔
S42.226D
Unspecified
2-part nondisplaced fracture of surgical neck of unspecified humerus, subsequent encounter for fracture with routine healing

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. S42.225D and S42.226D 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

S42.225D2-part nondisplaced fracture of surgical neck of left humerus, subsequent encounter for fracture with routine healingS42.226D2-part nondisplaced fracture of surgical neck of unspecified humerus, subsequent encounter for fracture with routine healing
Billing statusBillableBillable
ClassificationS00-T88 — Injury, poisoning and certain other consequences of external causesS00-T88 — Injury, poisoning and certain other consequences of external causes
Definition2-part nondisplaced fracture of surgical neck of left humerus, subsequent encounter for fracture with routine healing is a billable ICD-10-CM diagnosis code (S42.225D).2-part nondisplaced fracture of surgical neck of unspecified humerus, subsequent encounter for fracture with routine healing is a billable ICD-10-CM diagnosis code (S42.226D).
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
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Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources