ICD-10 Coding for Right Humerus Fracture(S42.291A)
Complete ICD-10-CM coding and documentation guide for Right Humerus Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Humerus Fracture
S42.2-S42.3Primary Range
Fracture of humerus
This range includes codes for fractures of the humerus, specifically addressing different parts and types of fractures.
Key Information: ICD-10 code for right humerus fracture
Essential facts and insights about Right Humerus Fracture
Primary ICD-10-CM Code for right humerus fracture
Decision Criteria
clinical Criteria
- Radiographic evidence of fracture displacement
documentation Criteria
- Clear documentation of initial encounter and closed fracture
Applicable To
- Displaced fracture of proximal right humerus
Excludes
- Pathological fracture (M84.4-)
Clinical Validation Requirements
- Radiographic confirmation of displacement
- Documentation of closed fracture
- Initial encounter status
Code-Specific Risks
- Incorrect laterality documentation
- Missing encounter type
Coding Notes
- Ensure documentation specifies displacement, laterality, and encounter type.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Periprosthetic fracture around internal prosthetic right shoulder joint, initial encounter
M97.11XADifferential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Pathological fracture of right humerus
S42.25xADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Right Humerus Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S42.291A.
Impact
Clinical: Leads to vague clinical records., Regulatory: Non-compliance with coding standards., Financial: Potential claim rejections.
Mitigation Strategy
Always specify fracture details., Use specific codes for laterality and encounter type.
Impact
Reimbursement: Claims may be denied or delayed., Compliance: Non-compliance with ICD-10 coding standards., Data Quality: Inaccurate patient records.
Mitigation Strategy
Always specify 'right' or 'left' in documentation.
Impact
Failure to document laterality can lead to audit flags.
Mitigation Strategy
Implement mandatory fields in EHR for 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 Right Humerus Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Humerus Fracture
Use these documentation templates to ensure complete and accurate documentation for Right Humerus Fracture. These templates include all required elements for proper coding and billing.
Initial Evaluation of Right Humerus Fracture
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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