ICD-10 Coding for Fracture of Humerus(S42.231A, S42.352B)
Complete ICD-10-CM coding and documentation guide for Fracture of 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 Humerus
S42.2-S42.4Primary Range
Fractures of the humerus, including proximal, shaft, and distal fractures
This range covers all types of humeral fractures, specifying location and characteristics.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S42.231A | Displaced 3-part fracture of right proximal humerus, initial encounter | Use for initial encounter of a displaced 3-part fracture of the right proximal humerus. |
|
| S42.352B | Open displaced fracture of left humeral shaft with radial nerve palsy, subsequent encounter | Use for subsequent encounters of an open displaced fracture of the left humeral shaft with nerve injury. |
|
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 Humerus
Primary ICD-10-CM Codes for fracture of humerus
Decision Criteria
clinical Criteria
- Displacement greater than 1 cm or angulation greater than 45°
documentation Criteria
- Initial encounter with detailed fracture description
Applicable To
- Displaced fracture of surgical neck of humerus
Excludes
- Pathological fracture of humerus (M84.5-)
Clinical Validation Requirements
- Radiographic evidence of displacement
- Documentation of fracture type and location
Code-Specific Risks
- Incorrect laterality documentation
- Omission of displacement details
Coding Notes
- Ensure documentation specifies displacement and laterality.
S42.352B - Open displaced fracture of left humeral shaft with radial nerve palsy, subsequent encounter
Use for subsequent encounters of an open displaced fracture of the left humeral shaft with nerve injury.
Applicable To
- Open fracture of humeral shaft with nerve injury
Excludes
- Closed fracture of humeral shaft (S42.3-)
Clinical Validation Requirements
- Surgical report confirming open fracture
- Nerve conduction studies if nerve injury is present
Coding Notes
Ensure Gustilo classification is documented for open fractures.
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 Humerus to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S42.231A.
Impact
Clinical: Can lead to incorrect treatment of the wrong limb., Regulatory: Non-compliance with coding guidelines., Financial: Potential for denied claims due to lack of specificity.
Mitigation Strategy
Always document right or left in the medical record., Use templates that prompt for laterality.
Impact
Reimbursement: May lead to lower DRG assignment and reimbursement., Compliance: Increases risk of audit due to lack of specificity., Data Quality: Reduces accuracy of clinical data for research and quality measures.
Mitigation Strategy
Always specify the fracture type, location, and displacement.
Impact
High incidence of unspecified codes leading to audit triggers.
Mitigation Strategy
Implement mandatory fields in EHR for fracture details.
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 Humerus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fracture of Humerus
Use these documentation templates to ensure complete and accurate documentation for Fracture of Humerus. These templates include all required elements for proper coding and billing.
Initial encounter for displaced proximal humerus fracture
Specialty: OrthopedicsRequired Elements
- Location and type of fracture
- Displacement and angulation details
- Initial treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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