ICD-10 Coding for Right Shoulder Fracture(S42.201A, S42.211A)
Complete ICD-10-CM coding and documentation guide for Right Shoulder Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Shoulder Fracture
S42.2Primary Range
Fracture of upper end of humerus
This range includes the most common types of right shoulder fractures, particularly those involving the proximal humerus.
Pathological fracture, not elsewhere classified
This range is used for pathological fractures of the shoulder due to underlying conditions like osteoporosis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S42.201A | Unspecified displaced fracture of right proximal humerus, initial encounter | Use when the fracture is confirmed as displaced but specific details are not documented. |
|
| S42.211A | 2-part displaced surgical neck fracture, right shoulder, initial encounter | Use when documentation specifies a 2-part 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 right shoulder fracture
Essential facts and insights about Right Shoulder Fracture
Primary ICD-10-CM Codes for fracture right shoulder
Decision Criteria
clinical Criteria
- Confirmed displacement on imaging
documentation Criteria
- Lack of specific fracture details
Applicable To
- Displaced fracture of right proximal humerus
Excludes
- Pathological fracture of right shoulder (M84.411A)
Clinical Validation Requirements
- X-ray or CT confirming displacement
Code-Specific Risks
- Risk of under-documenting specific fracture details
Coding Notes
- Ensure documentation specifies displacement and laterality.
S42.211A - 2-part displaced surgical neck fracture, right shoulder, initial encounter
Use when documentation specifies a 2-part fracture at the surgical neck.
Applicable To
- Displaced surgical neck fracture of right shoulder
Excludes
- Pathological fracture of right shoulder (M84.411A)
Clinical Validation Requirements
- Imaging showing 2-part fracture at surgical neck
Coding Notes
Ensure documentation specifies the fracture type and location.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Right Shoulder Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S42.201A.
Impact
Clinical: Incomplete clinical picture of injury circumstances., Regulatory: Non-compliance with ICD-10 coding standards., Financial: Potential loss of reimbursement for related services.
Mitigation Strategy
Always document the mechanism of injury., Use external cause codes to provide context.
Impact
Reimbursement: May lead to incorrect billing and reduced reimbursement., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data affecting patient care.
Mitigation Strategy
Ensure documentation includes detailed fracture description and laterality.
Impact
Coding fractures without specifying type and laterality increases audit risk.
Mitigation Strategy
Ensure thorough documentation and use of specific ICD-10 codes.
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 Shoulder Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Shoulder Fracture
Use these documentation templates to ensure complete and accurate documentation for Right Shoulder Fracture. These templates include all required elements for proper coding and billing.
Emergency Department Visit for Right Shoulder Fracture
Specialty: Emergency MedicineRequired Elements
- Patient history
- Mechanism of injury
- Physical examination findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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