FY2025 · 04-01
Effective from
- Inherited rules changed
Fracture of shoulder and upper arm
Category — select a more specific code
CDC/NCHS · FY2025 · 04-01A — 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
traumatic amputation of shoulder and upper arm (S48.-)
code to identify any retained foreign body, if applicable (Z18.-)
periprosthetic fracture around internal prosthetic shoulder joint (M97.3)
For US diagnosis claims covered by HIPAA, ICD-10-CM is required from October 1, 2015.
Use the service date for outpatient/professional claims and the discharge date for hospital inpatient claims. Earlier encounters use ICD-9-CM; each individual code must also be valid for the applicable date.
Official coding guidelines → · CMS ↗First observed · 2015-10-01
Latest recorded change · FY2025 · 04-01
Effective from
Fracture of shoulder and upper arm
Category — select a more specific code
CDC/NCHS · FY2025 · 04-01| All editions | Effective from | Code history |
|---|---|---|
| FY2016 | 2015-10-01 | First observed |
| FY2017 | 2016-10-01 | No tabular change |
| FY2018 | 2017-10-01 | No tabular change |
| FY2019 | 2018-10-01 | No tabular change |
| FY2020 | 2019-10-01 | No tabular change |
| FY2020 · April | 2020-04-01 | No tabular change |
| FY2021 | 2020-10-01 | No tabular change |
| FY2021 · 01-01 | 2021-01-01 | No tabular change |
| FY2022 | 2021-10-01 | No tabular change |
| FY2022 · 04-01 | 2022-04-01 | No tabular change |
| FY2023 | 2022-10-01 | No tabular change |
| FY2023 · 04-01 | 2023-04-01 | No tabular change |
| FY2024 | 2023-10-01 | Code-level rules changed |
| FY2024 · 04-01 | 2024-04-01 | No tabular change |
| FY2025 | 2024-10-01 | No tabular change |
| FY2025 · 04-01 | 2025-04-01 | Inherited rules changed |
| FY2026 | 2025-10-01 | No tabular change |
| FY2026 · April | 2026-04-01 | No tabular change |
| FY2027 | 2026-10-01 | No tabular change |
traumatic amputation of shoulder and upper arm (S48.-)
periprosthetic fracture around internal prosthetic shoulder joint (M97.3)
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
code to identify any retained foreign body, if applicable (Z18.-)
S42.0Fracture of clavicleCategory · further specificity requiredS42.1Fracture of scapulaCategory · further specificity requiredS42.2Fracture of upper end of humerusCategory · further specificity requiredS42.3Fracture of shaft of humerusCategory · further specificity requiredS42.4Fracture of lower end of humerusCategory · further specificity requiredS42.9Fracture of shoulder girdle, part unspecifiedCategory · further specificity requiredOfficial titles and instructions are preserved in their source language. Official sources ↗
Excludes 1 · traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-)
Excludes 1 · traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-)
Excludes 2 · open fracture of shoulder and upper arm (S42.- with 7th character B or C)