ICD-10 Coding for Fracture of Left Humerus(S42.202A, S42.292A)
Complete ICD-10-CM coding and documentation guide for Fracture of Left 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 Left Humerus
S42.2-S42.4Primary Range
Fractures of the humerus
This range includes all fractures of the humerus, specifying location and displacement.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S42.202A | Unspecified fracture of upper end of left humerus, initial encounter for closed fracture | Use when the fracture is confirmed but lacks specific anatomical details. |
|
| S42.292A | Displaced fracture of surgical neck of left humerus, initial encounter for closed fracture | Use when imaging confirms a displaced fracture at the surgical neck. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for fracture of left humerus
Essential facts and insights about Fracture of Left Humerus
Primary ICD-10-CM Codes for fracture of left humerus
Decision Criteria
clinical Criteria
- Fracture confirmed by imaging without specific anatomical details
Applicable To
- Unspecified closed fracture of upper left humerus
Excludes
- Displaced fractures
- Open fractures
Clinical Validation Requirements
- Clinical examination and imaging confirming fracture without specific anatomical details
Code-Specific Risks
- Risk of undercoding if more specific details are available.
Coding Notes
- Ensure to document the encounter type and any associated injuries.
S42.292A - Displaced fracture of surgical neck of left humerus, initial encounter for closed fracture
Use when imaging confirms a displaced fracture at the surgical neck.
Applicable To
- Displaced fracture of surgical neck, left humerus
Excludes
- Unspecified fractures
- Open fractures
Clinical Validation Requirements
- Imaging showing displacement at the surgical neck
Coding Notes
Document displacement and encounter type clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Fall from same level
W19.XXXADifferential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fracture of Left Humerus 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 decisions., Regulatory: Increased risk of audit failures., Financial: Potential for claim denials.
Mitigation Strategy
Ensure imaging reports are reviewed and documented., Use structured templates for documentation.
Impact
Reimbursement: Potential for lower reimbursement due to lack of specificity., Compliance: Increased risk of audits and denials., Data Quality: Poor data quality affecting clinical decision-making.
Mitigation Strategy
Always document and code the specific location and type of fracture.
Impact
High risk of audits when unspecified codes are used without justification.
Mitigation Strategy
Always document specific fracture details and use the most specific code available.
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 Left Humerus, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fracture of Left Humerus
Use these documentation templates to ensure complete and accurate documentation for Fracture of Left Humerus. These templates include all required elements for proper coding and billing.
Initial encounter for a closed fracture of the left humerus
Specialty: OrthopedicsRequired Elements
- Patient history
- Imaging results
- Neurovascular assessment
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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