ICD-10 Coding for Fracture of Right Humerus(S42.251A)
Complete ICD-10-CM coding and documentation guide for Fracture of Right 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 Right Humerus
S42.2-S42.4Primary Range
Fractures of humerus
This range includes codes for fractures of the upper end, shaft, and lower end of the humerus, which are relevant for coding fractures of the right humerus.
Key Information: ICD-10 code for displaced fracture of right humerus
Essential facts and insights about Fracture of Right Humerus
Primary ICD-10-CM Code for fracture right humerus
Decision Criteria
clinical Criteria
- Radiographic evidence of displacement
documentation Criteria
- Specific mention of fracture location and displacement
Applicable To
- Displaced fracture of greater tuberosity
Clinical Validation Requirements
- Radiographic evidence of displacement
- Clinical documentation of fracture location
Code-Specific Risks
- Misclassification if displacement is not documented
Coding Notes
- Ensure documentation specifies displacement and fracture location.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Fall, initial encounter
W19.XXXADifferential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Other nondisplaced fracture of upper end of right humerus, initial encounter
S42.291ADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fracture of Right Humerus to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S42.251A.
Impact
Clinical: May affect treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Always document displacement status, Use templates to ensure completeness
Impact
Reimbursement: May lead to incorrect DRG assignment and reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Ensure documentation specifies fracture location and displacement.
Impact
High risk of audit if unspecified codes are used.
Mitigation Strategy
Ensure documentation specifies 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 Right Humerus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fracture of Right Humerus
Use these documentation templates to ensure complete and accurate documentation for Fracture of Right Humerus. These templates include all required elements for proper coding and billing.
Initial encounter for displaced fracture
Specialty: OrthopedicsRequired Elements
- Fracture location
- Displacement status
- Encounter type
- External cause
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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