ICD-10 Coding for Distal Humerus Fracture(S42.452A)
Complete ICD-10-CM coding and documentation guide for Distal Humerus Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Distal Humerus Fracture
S42.4Primary Range
Fracture of lower end of humerus
This range includes all types of distal humerus fractures, specifying laterality, displacement, and encounter type.
Key Information: ICD-10 code for left distal humerus fracture
Essential facts and insights about Distal Humerus Fracture
Primary ICD-10-CM Code for distal humerus fracture
Decision Criteria
clinical Criteria
- Radiographic confirmation of displacement
documentation Criteria
- Initial encounter status must be documented
Applicable To
- Displaced lateral condyle fracture
Clinical Validation Requirements
- Radiographic evidence of displacement >2mm
- Initial encounter documentation
Code-Specific Risks
- Incorrect laterality
- Misclassification of displacement
Coding Notes
- Ensure documentation specifies laterality and displacement status.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for other orthopedic aftercare
Z47.89Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Displaced fracture of lateral condyle of right humerus, initial encounter for closed fracture
S42.451ADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Distal Humerus Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S42.452A.
Impact
Clinical: Leads to incorrect treatment planning., Regulatory: Non-compliance with ICD-10 coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always verify and document laterality., Use templates that prompt for laterality.
Impact
Reimbursement: Potential denial of claims due to incorrect coding., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Verify laterality in clinical documentation before coding.
Impact
High risk of audit if laterality is not documented.
Mitigation Strategy
Implement mandatory laterality checks in documentation workflows.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Distal Humerus Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Distal Humerus Fracture
Use these documentation templates to ensure complete and accurate documentation for Distal Humerus Fracture. These templates include all required elements for proper coding and billing.
Initial Encounter for Distal Humerus Fracture
Specialty: OrthopedicsRequired Elements
- Patient history
- Radiographic findings
- Displacement status
- Encounter type
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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