S42.199B Fracture of other part of scapula, unspecified shoulder, initial encounter for open fracture

Billable ICD-10-CM code, FY2026.

Built from S42.199 with 7th character B (initial encounter for open fracture).

Applies from S42 Fracture of shoulder and upper arm

Excludes1 (never code together)

• traumatic amputation of shoulder and upper arm (S48.-)

Excludes2 (not included here)

• periprosthetic fracture around internal prosthetic shoulder joint (M97.3)

7th character note

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

Notes

• A fracture not indicated as displaced or nondisplaced should be coded to displaced
• A fracture not indicated as open or closed should be coded to closed

7th character required

• 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

Medicare Code Edits (MCE v43.1 (April 2026))

• Unspecified code (laterality): Unspecified codes for which a more specific code identifying laterality (right, left, bilateral) exists within the same code family.

Code annotations containing back-references to S42.199B

Back-references to S42.1

• Type 2 Excludes: S22 Fracture of rib(s), sternum and thoracic spine ("fracture of scapula (S42.1-)")

Back-references to S42

• Type 1 Excludes: M84.3 Stress fracture ("traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-)")
• Type 1 Excludes: M84.4 Pathological fracture, not elsewhere classified ("traumatic fracture (S12.-, S22.-, S32.-, S42.-, S52.-, S62.-, S72.-, S82.-, S92.-)")
• Type 2 Excludes: S41 Open wound of shoulder and upper arm ("open fracture of shoulder and upper arm (S42.- with 7th character B or C)")

Nearby codes

• S42.192K Fracture of other part of scapula, left shoulder, subsequent encounter for fracture with nonunion
• S42.192P Fracture of other part of scapula, left shoulder, subsequent encounter for fracture with malunion
• S42.192S Fracture of other part of scapula, left shoulder, sequela
• S42.199 Fracture of other part of scapula, unspecified shoulder
• S42.199A Fracture of other part of scapula, unspecified shoulder, initial encounter for closed fracture
• S42.199B Fracture of other part of scapula, unspecified shoulder, initial encounter for open fracture (this code)
• S42.199D Fracture of other part of scapula, unspecified shoulder, subsequent encounter for fracture with routine healing
• S42.199G Fracture of other part of scapula, unspecified shoulder, subsequent encounter for fracture with delayed healing
• S42.199K Fracture of other part of scapula, unspecified shoulder, subsequent encounter for fracture with nonunion
• S42.199P Fracture of other part of scapula, unspecified shoulder, subsequent encounter for fracture with malunion
• S42.199S Fracture of other part of scapula, unspecified shoulder, sequela