ICD-10 category · Chapter XIX · S40-S49

S42 Fracture of shoulder and upper arm

25 codes under S42 in the South African Master Industry Table 2021, 16 valid for clinical use; 16 marked as a Prescribed Minimum Benefit.

Valid: the code is at its most specific level and may go on an account. Heading only: code to a more specific entry beneath it. PMB and CDL: a Prescribed Minimum Benefit or Chronic Disease List condition per the Council for Medical Schemes. † dagger and * asterisk codes are used as a pair. How to read the table
Code	Description	Use	Benefits
S42	Fracture of shoulder and upper arm	Heading only	—
S42.0	Fracture of clavicle	Heading only	—
S42.00	Fracture of clavicle, closed	Valid · may be primary	PMB 902H Closed fractures/ dislocations of limb bones / epiphyses – excluding fingers and toes · Reduction / relocation
S42.01	Fracture of clavicle, open	Valid · may be primary	PMB 900H Open fracture / dislocation of bones and joints · Reduction / relocation; medical and surgical management
S42.1	Fracture of scapula	Heading only	—
S42.10	Fracture of scapula, closed	Valid · may be primary	PMB 902H Closed fractures/ dislocations of limb bones / epiphyses – excluding fingers and toes · Reduction / relocation
S42.11	Fracture of scapula, open	Valid · may be primary	PMB 900H Open fracture / dislocation of bones and joints · Reduction / relocation; medical and surgical management
S42.2	Fracture of upper end of humerus	Heading only	—
S42.20	Fracture of upper end of humerus, closed	Valid · may be primary	PMB 902H Closed fractures/ dislocations of limb bones / epiphyses – excluding fingers and toes · Reduction / relocation
S42.21	Fracture of upper end of humerus, open	Valid · may be primary	PMB 900H Open fracture / dislocation of bones and joints · Reduction / relocation; medical and surgical management
S42.3	Fracture of shaft of humerus	Heading only	—
S42.30	Fracture of shaft of humerus, closed	Valid · may be primary	PMB 902H Closed fractures/ dislocations of limb bones / epiphyses – excluding fingers and toes · Reduction / relocation
S42.31	Fracture of shaft of humerus, open	Valid · may be primary	PMB 900H Open fracture / dislocation of bones and joints · Reduction / relocation; medical and surgical management
S42.4	Fracture of lower end of humerus	Heading only	—
S42.40	Fracture of lower end of humerus, closed	Valid · may be primary	PMB 902H Closed fractures/ dislocations of limb bones / epiphyses – excluding fingers and toes · Reduction / relocation
S42.41	Fracture of lower end of humerus, open	Valid · may be primary	PMB 900H Open fracture / dislocation of bones and joints · Reduction / relocation; medical and surgical management
S42.7	Multiple fractures of clavicle, scapula and humerus	Heading only	—
S42.70	Multiple fractures of clavicle, scapula and humerus, closed	Valid · may be primary	PMB 902H Closed fractures/ dislocations of limb bones / epiphyses – excluding fingers and toes · Reduction / relocation
S42.71	Multiple fractures of clavicle, scapula and humerus, open	Valid · may be primary	PMB 900H Open fracture / dislocation of bones and joints · Reduction / relocation; medical and surgical management
S42.8	Fracture of other parts of shoulder and upper arm	Heading only	—
S42.80	Fracture of other parts of shoulder and upper arm, closed	Valid · may be primary	PMB 902H Closed fractures/ dislocations of limb bones / epiphyses – excluding fingers and toes · Reduction / relocation
S42.81	Fracture of other parts of shoulder and upper arm, open	Valid · may be primary	PMB 900H Open fracture / dislocation of bones and joints · Reduction / relocation; medical and surgical management
S42.9	Fracture of shoulder girdle, part unspecified	Heading only	—
S42.90	Fracture of shoulder girdle, part unspecified, closed	Valid · may be primary	PMB 902H Closed fractures/ dislocations of limb bones / epiphyses – excluding fingers and toes · Reduction / relocation
S42.91	Fracture of shoulder girdle, part unspecified, open	Valid · may be primary	PMB 900H Open fracture / dislocation of bones and joints · Reduction / relocation; medical and surgical management

Prescribed Minimum Benefits in S42. A medical scheme must fund the diagnosis, treatment and care of a PMB condition in full, within its rules on designated providers and treatment protocols. The PMB code and treatment component beside each code come from the Council for Medical Schemes’ PMB Coded List; the scheme decides whether a given claim qualifies.

Source and terms

Reproduced from the national table, unaltered.

The Department publishes the table for the industry to load. The ICD-10 Master Industry Table page

Codes and descriptions: ICD-10 Master Industry Table (MIT) 2021, published 16 March 2021 by the National Department of Health, Republic of South Africa. ® National Department of Health: all rights reserved. Reproduced for reference without alteration.

ICD-10 is the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, © World Health Organization. The WHO ICD-10 descriptions appear as published in the MIT.

Prescribed Minimum Benefit (PMB) and Chronic Disease List (CDL) markers: Council for Medical Schemes, PMB Coded List, as read by GreenNotes. Benefit decisions rest with each medical scheme.

Source file: ICD-10_MIT_2021_Excel_16-March_2021.xlsx. Found an error in a code or description? Write to help@greennotes.co.za.

This lookup is a reference to the published code table, not coding advice. Code assignment is the treating practitioner’s responsibility, following the South African ICD-10 Coding Standards and Guidelines and the WHO ICD-10 volumes. GreenNotes does not warrant that the table is complete or current.

This is the South African table. Most ICD-10 results online are the United States’ ICD-10-CM, a different code set that South African medical schemes do not accept. Regulation 5 of the General Regulations under the Medical Schemes Act requires the diagnostic code on every account, and the Master Industry Table is the list it is coded from.

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