S42 is the authoritative medical code for Fracture of shoulder and upper arm. This classification is used in medical billing and clinical recording to specify the clinical criteria for fracture of shoulder and upper arm (ICD-10-CM S42), ensuring healthcare documentation aligns with 2026 federal coding standards.
Billing Status: NO. This is a clinician non-billable / parent hierarchy grouping in the ICD-10-CM system.
Official Registry Overview & Definition
Fracture of shoulder and upper arm is a non-billable ICD-10-CM category code S42. A more specific billable subcode must be selected for claims submission. Includes: injuries of axilla; injuries of scapular region. Excludes1 (not coded here): traumatic amputation of shoulder and upper arm S48.-. Excludes2 (not included here): periprosthetic fracture around internal prosthetic shoulder joint M97.3; burns and corrosions T20-T32; frostbite T33-T34; injuries of elbow S50-S59; insect bite or sting, venomous T63.4. 7th character: The appropriate 7th character is to be added to all codes from category S42.
Official Tabular Instructional Notes
Sequencing, inclusion, and exclusion notes published for S42 in the official ICD-10-CM tabular list.
Includes
Conditions the official ICD-10-CM tabular list includes under this code.
- injuries of axilla
- injuries of scapular region
Excludes1 — Not Coded Here
Conditions that can never be reported with this code; the two are mutually exclusive.
- traumatic amputation of shoulder and upper arm S48.-
Excludes2 — Not Included Here
Conditions not covered by this code, but which may be reported alongside it when both are present.
- periprosthetic fracture around internal prosthetic shoulder joint M97.3
- burns and corrosions T20-T32
- frostbite T33-T34
- injuries of elbow S50-S59
- insect bite or sting, venomous T63.4
Frequently Asked Questions (FAQ) & Clinical Guidance
Can S42 be billed directly?
No. S42 (Fracture of shoulder and upper arm) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.
Does S42 require a 7th character?
Yes. The appropriate 7th character is to be added to all codes from category S42.
What can't be coded together with S42?
Per Excludes1 instructions, S42 must not be reported with: traumatic amputation of shoulder and upper arm (S48.-).
Can S42 be reported alongside related conditions?
Per Excludes2 instructions, S42 and the following may both be reported when both are present: periprosthetic fracture around internal prosthetic shoulder joint (M97.3); burns and corrosions (T20-T32); frostbite (T33-T34); injuries of elbow (S50-S59).
Codes in This Family (40)
Official ICD-10-CM classifications in the same code family as S42, with their registry titles.
- S42.0 — Fracture of clavicle
- S42.001 — Fracture of unspecified part of right clavicle
- S42.001A — Fracture of unspecified part of right clavicle, initial encounter for closed fracture
- S42.001B — Fracture of unspecified part of right clavicle, initial encounter for open fracture
- S42.001D — Fracture of unspecified part of right clavicle, subsequent encounter for fracture with routine healing
- S42.001G — Fracture of unspecified part of right clavicle, subsequent encounter for fracture with delayed healing
- S42.001K — Fracture of unspecified part of right clavicle, subsequent encounter for fracture with nonunion
- S42.001P — Fracture of unspecified part of right clavicle, subsequent encounter for fracture with malunion
- S42.001S — Fracture of unspecified part of right clavicle, sequela
- S42.002 — Fracture of unspecified part of left clavicle
- S42.002A — Fracture of unspecified part of left clavicle, initial encounter for closed fracture
- S42.002B — Fracture of unspecified part of left clavicle, initial encounter for open fracture
- S42.002D — Fracture of unspecified part of left clavicle, subsequent encounter for fracture with routine healing
- S42.002G — Fracture of unspecified part of left clavicle, subsequent encounter for fracture with delayed healing
- S42.002K — Fracture of unspecified part of left clavicle, subsequent encounter for fracture with nonunion
- S42.002P — Fracture of unspecified part of left clavicle, subsequent encounter for fracture with malunion
- S42.002S — Fracture of unspecified part of left clavicle, sequela
- S42.009 — Fracture of unspecified part of unspecified clavicle
- S42.009A — Fracture of unspecified part of unspecified clavicle, initial encounter for closed fracture
- S42.009B — Fracture of unspecified part of unspecified clavicle, initial encounter for open fracture
- S42.009D — Fracture of unspecified part of unspecified clavicle, subsequent encounter for fracture with routine healing
- S42.009G — Fracture of unspecified part of unspecified clavicle, subsequent encounter for fracture with delayed healing
- S42.009K — Fracture of unspecified part of unspecified clavicle, subsequent encounter for fracture with nonunion
- S42.009P — Fracture of unspecified part of unspecified clavicle, subsequent encounter for fracture with malunion
- S42.009S — Fracture of unspecified part of unspecified clavicle, sequela
- S42.011 — Anterior displaced fracture of sternal end of right clavicle
- S42.011A — Anterior displaced fracture of sternal end of right clavicle, initial encounter for closed fracture
- S42.011B — Anterior displaced fracture of sternal end of right clavicle, initial encounter for open fracture
- S42.011D — Anterior displaced fracture of sternal end of right clavicle, subsequent encounter for fracture with routine healing
- S42.011G — Anterior displaced fracture of sternal end of right clavicle, subsequent encounter for fracture with delayed healing
- S42.011K — Anterior displaced fracture of sternal end of right clavicle, subsequent encounter for fracture with nonunion
- S42.011P — Anterior displaced fracture of sternal end of right clavicle, subsequent encounter for fracture with malunion
- S42.011S — Anterior displaced fracture of sternal end of right clavicle, sequela
- S42.012 — Anterior displaced fracture of sternal end of left clavicle
- S42.012A — Anterior displaced fracture of sternal end of left clavicle, initial encounter for closed fracture
- S42.012B — Anterior displaced fracture of sternal end of left clavicle, initial encounter for open fracture
- S42.012D — Anterior displaced fracture of sternal end of left clavicle, subsequent encounter for fracture with routine healing
- S42.012G — Anterior displaced fracture of sternal end of left clavicle, subsequent encounter for fracture with delayed healing
- S42.012K — Anterior displaced fracture of sternal end of left clavicle, subsequent encounter for fracture with nonunion
- S42.012P — Anterior displaced fracture of sternal end of left clavicle, subsequent encounter for fracture with malunion
Related Codes & Numerical Sequence (Crawl Map)
Search engines and indexers are advised to traverse adjacent medical codes in this sub-chapter range to find correlated diagnoses or therapeutic procedures:
ICD Code S38
Crushing injury and traumatic amputation of abdomen, lower back, pelvis and external genitals
ICD Code S39
Other and unspecified injuries of abdomen, lower back, pelvis and external genitals
ICD Code S43
Dislocation and sprain of joints and ligaments of shoulder girdle
ICD Code S44
Injury of nerves at shoulder and upper arm level
ICD Code S45
Injury of blood vessels at shoulder and upper arm level
ICD Code S46
Injury of muscle, fascia and tendon at shoulder and upper arm level