ICD-10 Coding for Humerus Fracture(S42.202A)
Complete ICD-10-CM coding and documentation guide for Humerus Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Humerus Fracture
S42.2-S42.4Primary Range
Fractures of the humerus
This range covers all types of humerus fractures including proximal, shaft, and distal fractures.
Key Information: ICD-10 code for humerus fracture
Essential facts and insights about Humerus Fracture
Primary ICD-10-CM Code for humerus fracture
Decision Criteria
clinical Criteria
- Presence of shoulder deformity and pain with arm abduction
Applicable To
- Proximal humerus fracture
Excludes
- Pathological fracture (M84.4-)
Clinical Validation Requirements
- X-ray confirmation of fracture
- Clinical examination showing shoulder deformity
Code-Specific Risks
- Risk of incorrect coding if laterality is not specified
Coding Notes
- Ensure laterality is documented to avoid unspecified coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Age-related osteoporosis with current pathological fracture, left humerus
M80.011ADifferential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Fracture of shaft of humerus, initial encounter for closed fracture
S42.392ADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Humerus Fracture 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 plans., Regulatory: Non-compliance with coding guidelines., Financial: Potential for claim denials.
Mitigation Strategy
Ensure all relevant clinical details are documented., Review imaging and clinical notes before coding.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with ICD-10 coding standards., Data Quality: Inaccurate patient records.
Mitigation Strategy
Always document whether the fracture is on the right or left humerus.
Impact
High risk of audits if laterality is not specified.
Mitigation Strategy
Implement mandatory laterality documentation in EHR systems.
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 Humerus Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Humerus Fracture
Use these documentation templates to ensure complete and accurate documentation for Humerus Fracture. These templates include all required elements for proper coding and billing.
Initial encounter for closed fracture of the left humerus
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Physical exam findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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