ICD-10 Coding for Fracture of the Humerus(S42.2, S42.3)
Complete ICD-10-CM coding and documentation guide for Fracture of the Humerus. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fracture of the Humerus
S42.2-S42.4Primary Range
Fractures of the humerus, including upper end, shaft, and lower end
These codes cover the various anatomical locations of humeral fractures, crucial for accurate diagnosis and treatment documentation.
Pathological fractures of the humerus
These codes are used when the fracture is due to an underlying pathological condition, such as osteoporosis or cancer.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S42.2 | Fracture of upper end of humerus | Use when the fracture is located at the proximal end of the humerus. |
|
| S42.3 | Fracture of shaft of humerus | Use when the fracture is located along the shaft of the humerus. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for humerus fracture
Essential facts and insights about Fracture of the Humerus
Primary ICD-10-CM Codes for fracture humerus
Decision Criteria
clinical Criteria
- Fracture confirmed by imaging at the proximal humerus
documentation Criteria
- Specify laterality and fracture type
Applicable To
- Proximal humerus fracture
- Fracture of humeral head
Excludes
- Pathological fracture of humerus (M84.42-)
Clinical Validation Requirements
- X-ray confirmation of fracture location
- Documentation of fracture type (e.g., displaced, comminuted)
Code-Specific Risks
- Incorrect documentation of laterality
- Failure to specify fracture type
Coding Notes
- Ensure documentation includes laterality and fracture type.
S42.3 - Fracture of shaft of humerus
Use when the fracture is located along the shaft of the humerus.
Applicable To
- Mid-shaft humerus fracture
Excludes
- Pathological fracture of humerus (M84.52-)
Clinical Validation Requirements
- X-ray showing fracture along the shaft
- Documentation of displacement and angulation
Coding Notes
Document any associated nerve injuries.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fracture of the Humerus to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S42.2.
Impact
Clinical: May affect treatment decisions., Regulatory: Non-compliance with documentation standards., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Include displacement in all fracture documentation., Use templates to ensure completeness.
Impact
Reimbursement: May lead to denied claims due to unspecified codes., Compliance: Non-compliance with coding standards., Data Quality: Decreases accuracy of patient records.
Mitigation Strategy
Always specify right or left in the documentation.
Impact
Reimbursement: Unspecified codes may result in lower reimbursement rates., Compliance: Fails to meet detailed coding requirements., Data Quality: Impacts research and data analysis quality.
Mitigation Strategy
Provide detailed documentation to avoid unspecified codes.
Impact
High risk of audit for using unspecified codes without detailed documentation.
Mitigation Strategy
Provide complete documentation including fracture type, location, and laterality.
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 Fracture of the Humerus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fracture of the Humerus
Use these documentation templates to ensure complete and accurate documentation for Fracture of the Humerus. These templates include all required elements for proper coding and billing.
Orthopedic evaluation of humerus fracture
Specialty: OrthopedicsRequired Elements
- Fracture location
- Type and displacement
- Neurovascular status
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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