S42.90XA vs S42.90XP

S42.90XA (Fracture of unspecified shoulder girdle, part unspecified, initial encounter for closed fracture) compared with S42.90XP (Fracture of unspecified shoulder girdle, part unspecified, subsequent encounter for fracture with malunion), from the official CMS tabular data. S42.90XA and S42.90XP code the same injury at a different phase of treatment.

Relationship

Review

Encounter relationship

S42.90XA

Initial encounter

Fracture of unspecified shoulder girdle, part unspecified, initial encounter for closed fracture

↔

S42.90XP

Subsequent encounter

Fracture of unspecified shoulder girdle, part unspecified, subsequent encounter for fracture with malunion

Same underlying diagnosis, different encounter phase.

The 7th character records the phase of care for the encounter being coded, so a single encounter takes one of these characters, not several. Review whether both phases belong on the same episode of care.

Source: ICD-10-CM Official Guidelines, Section I.C.19.a

Can these codes be reported together?

Same injury, other encounter phase. S42.90XA and S42.90XP code the same injury at a different phase of treatment, set by the 7th character.

The 7th character records the type of care given at the encounter being coded (ICD-10-CM Official Guidelines, Section I.C.19.a), so one encounter takes one of these, not both.

Side by side

	S42.90XAFracture of unspecified shoulder girdle, part unspecified, initial encounter for closed fracture	S42.90XPFracture of unspecified shoulder girdle, part unspecified, subsequent encounter for fracture with malunion
Billing status	Billable	Billable
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 unspecified shoulder girdle, part unspecified, initial encounter for closed fracture is a billable ICD-10-CM diagnosis code (S42.90A).	Fracture of unspecified shoulder girdle, part unspecified, subsequent encounter for fracture with malunion is a billable ICD-10-CM diagnosis code (S42.90P).
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 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