S42.40 ICD-10-CM Code: Unspecified fracture of lower end of humerus
Billing Status: NO. This is a clinician non-billable / parent hierarchy grouping in the ICD-10-CM system.
Official Registry Overview & Definition
Official Tabular Instructional Notes
Sequencing, inclusion, and exclusion notes published for S42.40 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
Inclusion Terms
Alternative terms the tabular list files under this code.
- Fracture of elbow NOS
Excludes1 — Not Coded Here
Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).
- traumatic amputation of shoulder and upper arm (S48.-) Compare S42.40 vs S48 →
Excludes2 — Not Included Here
Conditions not covered by this code, but which may be reported alongside it when both are present.
- fracture of shaft of humerus (S42.3-) Compare S42.40 vs S42.3 →
- physeal fracture of lower end of humerus (S49.1-) Compare S42.40 vs S49.1 →
- periprosthetic fracture around internal prosthetic shoulder joint (M97.3) Compare S42.40 vs M97.3 →
- burns and corrosions (T20-T32) Compare S42.40 vs T20 →
- frostbite (T33-T34) Compare S42.40 vs T33 →
- injuries of elbow (S50-S59) Compare S42.40 vs S50 →
- insect bite or sting, venomous (T63.4) Compare S42.40 vs T63.4 →
Frequently Compared Codes
The official Excludes notes on S42.40 name these codes. Each comparison page covers when the two can — or must not — be reported together.
Change history
No changes recorded for this code — unchanged since the FY2016 baseline of the change ledger.
Verify Before Coding
- Not billable as written — a more specific code is required: S42.401A, S42.401B, S42.401D, S42.401G, S42.401K.
- Requires a 7th character. "The appropriate 7th character is to be added to all codes from category S42" Options: S42.401A, S42.401B, S42.401D, S42.401G, S42.401K, S42.401P
From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim.
Contextual Map
Every relationship of S42.40 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.
Hierarchy
- S00-T88 — Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) (S00-T88) [Hierarchy]
Referenced by Excludes1 notes
- M84.3 — Stress fracture [Excludes1](via S42.-): “traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-)” · check together
- M84.4 — Pathological fracture, not elsewhere classified [Excludes1](via S42.-): “traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-)” · check together
Referenced by Excludes2 notes
- S41 — Open wound of shoulder and upper arm [Excludes2](via S42.-): “open fracture of shoulder and upper arm (S42.- with 7th character B or C)” · check together
- S52.0 — Fracture of upper end of ulna [Excludes2]: “fracture of elbow NOS (S42.40-)” · check together
Nearest codes (40)
- S42 — Fracture of shoulder and upper arm [Sibling]
- S42.391K — Other fracture of shaft of right humerus, subsequent encounter for fracture with nonunion [Sibling]
- S42.391P — Other fracture of shaft of right humerus, subsequent encounter for fracture with malunion [Sibling]
- S42.391S — Other fracture of shaft of right humerus, sequela [Sibling]
- S42.392 — Other fracture of shaft of left humerus [Sibling]
- S42.392A — Other fracture of shaft of left humerus, initial encounter for closed fracture [Sibling]
- S42.392B — Other fracture of shaft of left humerus, initial encounter for open fracture [Sibling]
- S42.392D — Other fracture of shaft of left humerus, subsequent encounter for fracture with routine healing [Sibling]
- and 32 more
Referenced by Other Codes
Official ICD-10-CM tabular notes on other codes that name S42.40 or its code family.
Frequently Asked Questions (FAQ) & Clinical Guidance
Can S42.40 be billed directly?
No. S42.40 (Unspecified fracture of lower end of humerus) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.
Does S42.40 require a 7th character?
Yes. The appropriate 7th character is to be added to all codes from category S42.
Nearest Codes in This Family
Official ICD-10-CM classifications closest to S42.40 in its code family, with their registry titles.
- S42.399G — Other fracture of shaft of unspecified humerus, subsequent encounter for fracture with delayed healing
- S42.399K — Other fracture of shaft of unspecified humerus, subsequent encounter for fracture with nonunion
- S42.399P — Other fracture of shaft of unspecified humerus, subsequent encounter for fracture with malunion
- S42.399S — Other fracture of shaft of unspecified humerus, sequela
- S42.4 — Fracture of lower end of humerus
- S42.401 — Unspecified fracture of lower end of right humerus
- S42.401A — Unspecified fracture of lower end of right humerus, initial encounter for closed fracture
- S42.401B — Unspecified fracture of lower end of right humerus, initial encounter for open fracture
- S42.401D — Unspecified fracture of lower end of right humerus, subsequent encounter for fracture with routine healing
- S42.401G — Unspecified fracture of lower end of right humerus, subsequent encounter for fracture with delayed healing