ICD-10 Coding for Fracture of the Left Humerus(S42.202A, S42.412A)
Complete ICD-10-CM coding and documentation guide for Fracture of the Left 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 Left Humerus
S42.2-S42.4Primary Range
Fractures of the humerus
This range includes codes for fractures of the humerus, specifying location, displacement, and encounter type.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S42.202A | Unspecified fracture of upper end of left humerus, initial encounter for closed fracture | Use when the fracture is at the upper end of the left humerus and is closed with no specific details on displacement. |
|
| S42.412A | Displaced supracondylar fracture of left humerus, initial encounter for closed fracture | Use when the fracture is displaced at the supracondylar region of the left 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 left humerus fracture
Essential facts and insights about Fracture of the Left Humerus
Primary ICD-10-CM Codes for fracture left humerus
Decision Criteria
clinical Criteria
- Fracture at the upper end of the left humerus with no displacement.
Applicable To
- Closed fracture of upper end of left humerus
Excludes
- Open fracture of upper end of left humerus
Clinical Validation Requirements
- X-ray confirms fracture at the upper end of the left humerus without displacement.
Code-Specific Risks
- Risk of undercoding if displacement is present but not documented.
Coding Notes
- Ensure documentation specifies the fracture location and encounter type.
S42.412A - Displaced supracondylar fracture of left humerus, initial encounter for closed fracture
Use when the fracture is displaced at the supracondylar region of the left humerus.
Applicable To
- Displaced supracondylar fracture of left humerus
Excludes
- Nondisplaced supracondylar fracture of left humerus
Clinical Validation Requirements
- X-ray shows displacement at the supracondylar region of the left humerus.
Coding Notes
Document the displacement and specific fracture location.
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 Left Humerus to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S42.202A.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Increases risk of audit and penalties., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Train staff on documentation standards., Use checklists to ensure all details are recorded.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audit and non-compliance., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Ensure documentation includes specific details such as displacement and fracture location.
Impact
High audit risk when using unspecified codes without supporting documentation.
Mitigation Strategy
Ensure all documentation includes specific details such as displacement and fracture location.
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 Left Humerus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fracture of the Left Humerus
Use these documentation templates to ensure complete and accurate documentation for Fracture of the Left Humerus. These templates include all required elements for proper coding and billing.
Initial encounter for a displaced fracture of the left humerus
Specialty: OrthopedicsRequired Elements
- Fracture location
- Displacement status
- Encounter type
- Imaging findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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