S42.91XA (Fracture of right shoulder girdle, part unspecified, initial encounter for closed fracture) compared with S42.91XS (Fracture of right shoulder girdle, part unspecified, sequela), from the official CMS tabular data. S42.91XA and S42.91XS code the same injury at a different phase of treatment. MedCoder-derived
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
Same injury, other encounter phase. S42.91XA and S42.91XS 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.
| S42.91XAFracture of right shoulder girdle, part unspecified, initial encounter for closed fracture | S42.91XSFracture of right shoulder girdle, part unspecified, sequela | |
|---|---|---|
| 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 right shoulder girdle, part unspecified, initial encounter for closed fracture is a billable ICD-10-CM diagnosis code (S42.91A). | Fracture of right shoulder girdle, part unspecified, sequela is a billable ICD-10-CM diagnosis code (S42.91S). |
| 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 |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources