ICD-10 Coding for Humeral Head Fracture(S42.211A)
Complete ICD-10-CM coding and documentation guide for Humeral Head Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Humeral Head Fracture
Key Information: ICD-10 code for humeral head fracture
Essential facts and insights about Humeral Head Fracture
Primary ICD-10-CM Code for humeral head fracture
Decision Criteria
clinical Criteria
- Displacement confirmed by imaging
documentation Criteria
- Laterality and displacement status documented
Applicable To
- Displaced fracture of right humeral head
Excludes
- Fracture of surgical neck of humerus
Clinical Validation Requirements
- Imaging confirmation of displacement
- Documentation of laterality
Code-Specific Risks
- Incorrect laterality documentation
- Failure to specify displacement
Coding Notes
- Ensure documentation specifies displacement and laterality.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Fall on stairs
W10.xxxADifferential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Anterior dislocation of humerus
S43.01xADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Humeral Head Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S42.211A.
Impact
Clinical: May lead to inappropriate treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential for claim denials
Mitigation Strategy
Use structured templates, Review imaging reports
Impact
Reimbursement: Potential for reduced reimbursement, Compliance: Non-compliance with coding guidelines, Data Quality: Decreased accuracy in data reporting
Mitigation Strategy
Ensure laterality is documented and coded correctly.
Impact
High use of unspecified codes can lead to audits.
Mitigation Strategy
Ensure complete documentation of laterality and displacement.
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 Humeral Head Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Humeral Head Fracture
Use these documentation templates to ensure complete and accurate documentation for Humeral Head Fracture. These templates include all required elements for proper coding and billing.
Initial Evaluation of Humeral Head Fracture
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Imaging results
- Neurovascular status
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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