ICD-10 Coding for Hill-Sachs Lesion(S42.292A)
Complete ICD-10-CM coding and documentation guide for Hill-Sachs Lesion. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hill-Sachs Lesion
S42.29Primary Range
Fracture of upper end of humerus
This range includes codes for fractures of the humerus, which is relevant for coding Hill-Sachs lesions as they are considered fractures of the posterolateral humeral head.
Superior glenoid labrum lesion
This range is relevant when a Hill-Sachs lesion is associated with a Bankart lesion, which involves the glenoid labrum.
Key Information: ICD-10 code for Hill-Sachs lesion
Essential facts and insights about Hill-Sachs Lesion
Primary ICD-10-CM Code for hill sachs lesion
Decision Criteria
clinical Criteria
- Imaging shows displaced fracture of the posterolateral humeral head.
documentation Criteria
- Documentation specifies 'displaced fracture' and laterality.
Applicable To
- Displaced Hill-Sachs fracture
Excludes
- Non-displaced fractures of the humerus
Clinical Validation Requirements
- Imaging confirmation of displacement
- Documentation of fracture type and laterality
Code-Specific Risks
- Risk of using without specifying laterality
- Risk of using without imaging confirmation
Coding Notes
- Ensure documentation specifies 'displaced fracture' and laterality.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Recurrent dislocation, shoulder, right
M24.411Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Nondisplaced fracture of upper end of humerus, initial encounter
S42.296ADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hill-Sachs Lesion to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S42.292A.
Impact
Clinical: May lead to incorrect treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims due to lack of specificity.
Mitigation Strategy
Always document laterality in clinical notes., Use templates that prompt for laterality.
Impact
Reimbursement: May result in lower reimbursement due to lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Always use the most specific code with the appropriate 7th character for encounter type.
Impact
Audits may focus on the specificity of fracture coding, particularly for Hill-Sachs lesions.
Mitigation Strategy
Ensure all documentation includes detailed descriptions of the fracture, including displacement 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 Hill-Sachs Lesion, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hill-Sachs Lesion
Use these documentation templates to ensure complete and accurate documentation for Hill-Sachs Lesion. These templates include all required elements for proper coding and billing.
Initial encounter for displaced Hill-Sachs lesion
Specialty: OrthopedicsRequired Elements
- Patient history of shoulder dislocation
- Imaging findings
- Fracture displacement and laterality
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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