S42.90XS ICD-10-CM Code: Fracture of unspecified shoulder girdle, part unspecified, sequela

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for S42.90XS in the official ICD-10-CM tabular list, quoted as published.

Notes without a marker are published on S42.90XS itself; “inherited from” names the category or block whose note applies here.

7th Character Guide

"The appropriate 7th character is to be added to all codes from category S42"

• A — initial encounter for closed fracture
• B — initial encounter for open fracture
• D — subsequent encounter for fracture with routine healing
• G — subsequent encounter for fracture with delayed healing
• K — subsequent encounter for fracture with nonunion
• P — subsequent encounter for fracture with malunion
• S — sequela (this page’s code)

How the encounter character is assigned. “Initial encounter” means the patient is receiving active treatment for the condition — it is not limited to the first visit, and a different or new provider giving active treatment still assigns it. “Subsequent encounter” covers care during the healing or recovery phase after active treatment. “Sequela” is for complications or conditions that arise as a direct result of the original condition.

ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19.a (paraphrased by MedCoder).

Variant codes in this family

S42.90XA, S42.90XB, S42.90XD, S42.90XG, S42.90XK, S42.90XP, S42.90XS

Character meanings are CMS's official 7th-character extensions for this family, as carried in each variant code's official description; variant codes are registry rows. The explanation of how the encounter character is assigned is MedCoder editorial, distinct from the official content above it.

Coder workflow for S42.90XS

MedCoder structured workflow — derived from this code’s own official record

Before you code S42.90XS

1. Unspecified does not mean incorrect. When the record gives no greater specificity, S42.90XS may be the appropriate code. Check the record for detail that supports a more specific sibling. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

   See the hierarchy · Guide: Other vs unspecified (NEC vs NOS) →

2. A 7th character is required in this family. Confirm the documented encounter: initial (active treatment), subsequent (healing or recovery phase), or sequela. This page’s code carries “S”. “Initial” means active treatment, not the first visit (Guidelines I.C.19.a).

   See the 7th Character Guide · Guide: 7th characters: initial, subsequent, sequela →

3. Confirm the injury type, the anatomical site at the most specific level documented, laterality where the family codes it, and the encounter for the 7th character. Each injury is coded separately unless the classification provides a combination code, and a superficial injury is not coded when a more severe injury of the same site is documented. A fracture not documented as open or closed is coded as closed; one not documented as displaced or nondisplaced is coded as displaced. Injury chapter guidelines (Guidelines I.C.19.b, I.C.19.b.1, I.C.19.c).

   Guide: Traumatic vs pathological vs stress fracture →

4. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with S42.90XS. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

   See the official tabular notes

Choose the right path

1. Does the record document the detail a more specific sibling code needs?
   Yes → Review the specific siblings in this subcategory.
   No → Continue — S42.90XS is appropriate when the documentation goes no further.
2. Does the documentation support a condition named in S42.90XS’s Excludes1 note?
   Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
   No → Continue.

   ReviewS48

3. Is the encounter phase documented — active treatment, healing or recovery, or a sequela?
   Yes → Assign the matching 7th character; the variant codes are in the 7th Character Guide.
   No → The code is invalid without its 7th character — query for the missing element.

Consider S42.90XS. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Anatomical site

At the most specific level the record states; a site the classification separates cannot be assumed from a procedure or a measurement.

Encounter type

Active treatment, healing or recovery phase, or sequela — the basis of the 7th character (Guidelines I.C.19.a).

Open or closed; displaced or nondisplaced

Defaults apply when the record is silent: closed, and displaced (Guidelines I.C.19.c).

External cause, place and activity

For the external cause codes reported with the injury or poisoning, where documented (Guidelines I.C.20.a).

Any detail beyond this code’s title

What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

• Excludes1 — check before selecting S42.90XS(1 note)

  Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with S42.90XS: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

  CompareS48

  See the official tabular notes · Guidelines I.A.12.a

• Excludes2 — not part of S42.90XS(5 notes)

  Coding workflow: The conditions named in this note are not included in S42.90XS. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareM97.3, T63.4

  See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Official Coding Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Don’t confuse S42.90XS with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of S42.90XS — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• S48— Excludes1 conflict (Conflict)

  Not coded here — these two are mutually exclusive.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of traumatic amputation of shoulder and upper arm moves the case to S48; the two are not reported together unless documented as unrelated.

  Full comparison: S42.90XS vs S48 →

• S42.91XS— Laterality relationship (Review)

  Same condition; these differ only in which side is documented.

  The same condition on the other side; the documented side decides, and a bilateral code, where one exists, replaces the pair when both sides are documented.

  What moves you there: A documented right side moves the case to S42.91XS.

  Full comparison: S42.90XS vs S42.91XS →

• S42.90XA— Encounter relationship (Review)

  Same underlying diagnosis, different encounter phase.

  The same diagnosis at a different phase of care; one encounter takes one 7th character.

  What moves you there: Documentation of a initial encounter for closed fracture moves the case to S42.90XA.

  Full comparison: S42.90XS vs S42.90XA →

• S42.90XB— Encounter relationship (Review)

  Same underlying diagnosis, different encounter phase.

  The same diagnosis at a different phase of care; one encounter takes one 7th character.

  What moves you there: Documentation of a initial encounter for open fracture moves the case to S42.90XB.

  Full comparison: S42.90XS vs S42.90XB →

• M97.3— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of periprosthetic fracture around internal prosthetic shoulder joint adds M97.3; it is not part of this code and both may be reported when both are documented.

  Full comparison: S42.90XS vs M97.3 →

• T20— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of burns and corrosions adds T20; it is not part of this code and both may be reported when both are documented.

  Full comparison: S42.90XS vs T20 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

1. A 7th character applies in this family. Confirm the documented encounter matches the character assigned. See the official 7th-character definitions and this code’s variants
2. 1 Excludes1 entry — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
3. 5 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

• No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

Other codes that name S42.90XS or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 2 Excludes1 notes: M84.3 — Stress fracture (via S42.-), M84.4 — Pathological fracture, not elsewhere classified (via S42.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 1 Excludes2 note: S41 — Open wound of shoulder and upper arm (via S42.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

Not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity.

Named in the grouper logic of 3 MS-DRGs: DRG 559 (MDC 08), DRG 560 (MDC 08), DRG 561 (MDC 08).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):INJ073 — Injury, sequela (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same condition, opposite side

Same category and title, differing only in which side of the body is affected.

S42.91XS — Fracture of right shoulder girdle, part unspecified, sequela (right)Compare S42.90XS vs S42.91XS →, S42.92XS — Fracture of left shoulder girdle, part unspecified, sequela (left)Compare S42.90XS vs S42.92XS →

Same injury, other encounter phase

Same injury, coded at a different phase of treatment via the 7th character.

S42.90XA — Fracture of unspecified shoulder girdle, part unspecified, initial encounter for closed fractureCompare S42.90XS vs S42.90XA →, S42.90XB — Fracture of unspecified shoulder girdle, part unspecified, initial encounter for open fracture, S42.90XD — Fracture of unspecified shoulder girdle, part unspecified, subsequent encounter for fracture with routine healing, S42.90XG — Fracture of unspecified shoulder girdle, part unspecified, subsequent encounter for fracture with delayed healing, S42.90XK — Fracture of unspecified shoulder girdle, part unspecified, subsequent encounter for fracture with nonunion, S42.90XP — Fracture of unspecified shoulder girdle, part unspecified, subsequent encounter for fracture with malunion

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Injury, sequela).

+7578 more

Contextual Map

Every relationship of S42.90XS 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.

Run S42.90XS with these 3 related codes in Claim Check

Hierarchy

• S00-T88 — Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) (S00-T88)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• S40-S49 — Injuries to the shoulder and upper arm[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes1 notes

• M84.3 — Stress fracture[Excludes1](via S42.-): “traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• M84.4 — Pathological fracture, not elsewhere classified[Excludes1](via S42.-): “traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

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)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• INJ073 — Injury, sequela[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• DRG 559 — AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC[MS-DRG]: “AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC (MDC 08)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 560 — AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC[MS-DRG]: “AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC (MDC 08)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 561 — AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC[MS-DRG]: “AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC (MDC 08)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 08 — Diseases and Disorders of the Musculoskeletal System and Connective Tissue[MDC crossing]: “Diseases and Disorders of the Musculoskeletal System and Connective Tissue — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 18,508 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Nearest codes (40)

• S42 — Fracture of shoulder and upper arm[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• S42.495 — Other nondisplaced fracture of lower end of left humerus[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• S42.495A — Other nondisplaced fracture of lower end of left humerus, initial encounter for closed fracture[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• S42.495B — Other nondisplaced fracture of lower end of left humerus, initial encounter for open fracture[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• S42.495D — Other nondisplaced fracture of lower end of left humerus, subsequent encounter for fracture with routine healing[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• S42.495G — Other nondisplaced fracture of lower end of left humerus, subsequent encounter for fracture with delayed healing[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• S42.495K — Other nondisplaced fracture of lower end of left humerus, subsequent encounter for fracture with nonunion[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• S42.495P — Other nondisplaced fracture of lower end of left humerus, subsequent encounter for fracture with malunion[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 32 more

Change history

• FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Common coding questions

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Coding guidelines Official source data

ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to S42.90XS in its code family, with their registry titles.

• S42.90XB — Fracture of unspecified shoulder girdle, part unspecified, initial encounter for open fracture
• S42.90XD — Fracture of unspecified shoulder girdle, part unspecified, subsequent encounter for fracture with routine healing
• S42.90XG — Fracture of unspecified shoulder girdle, part unspecified, subsequent encounter for fracture with delayed healing
• S42.90XK — Fracture of unspecified shoulder girdle, part unspecified, subsequent encounter for fracture with nonunion
• S42.90XP — Fracture of unspecified shoulder girdle, part unspecified, subsequent encounter for fracture with malunion
• S42.91 — Fracture of right shoulder girdle, part unspecified
• S42.91XA — Fracture of right shoulder girdle, part unspecified, initial encounter for closed fracture
• S42.91XB — Fracture of right shoulder girdle, part unspecified, initial encounter for open fracture
• S42.91XD — Fracture of right shoulder girdle, part unspecified, subsequent encounter for fracture with routine healing
• S42.91XG — Fracture of right shoulder girdle, part unspecified, subsequent encounter for fracture with delayed healing

View all codes in the S42 family