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S42.295B vs S42.296B

S42.295B (Other nondisplaced fracture of upper end of left humerus, initial encounter for open fracture) compared with S42.296B (Other nondisplaced fracture of upper end of unspecified humerus, initial encounter for open fracture), from the official CMS tabular data. S42.295B and S42.296B code the same condition on opposite sides. MedCoder-derived

Relationship

Review

Laterality relationship

S42.295B
Left
Other nondisplaced fracture of upper end of left humerus, initial encounter for open fracture
↔
S42.296B
Unspecified
Other nondisplaced fracture of upper end of unspecified humerus, initial encounter for open fracture

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. S42.295B and S42.296B 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

S42.295BOther nondisplaced fracture of upper end of left humerus, initial encounter for open fractureS42.296BOther nondisplaced fracture of upper end of unspecified humerus, initial encounter for open fracture
Billing statusBillableBillable
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)
DefinitionOther nondisplaced fracture of upper end of left humerus, initial encounter for open fracture is a billable ICD-10-CM diagnosis code (S42.295B).Other nondisplaced fracture of upper end of unspecified humerus, initial encounter for open fracture is a billable ICD-10-CM diagnosis code (S42.296B).
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