ICD-10 Coding for Humeral Fracture(S42.292B, S42.395D)
Complete ICD-10-CM coding and documentation guide for Humeral Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Humeral Fracture
S42.2-S42.3Primary Range
Fractures of the humerus
This range includes all types of humeral fractures, including proximal, shaft, and distal fractures.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S42.292B | Displaced open fracture of upper end of left humerus, initial encounter for open fracture | Use when there is a confirmed displaced open fracture of the upper end of the left humerus. |
|
| S42.395D | Displaced fracture of shaft of left humerus, subsequent encounter for fracture with routine healing | Use for follow-up visits when the patient is healing from a displaced shaft fracture of the left humerus. |
|
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 displaced humeral fracture
Essential facts and insights about Humeral Fracture
Primary ICD-10-CM Codes for humeral fracture
Decision Criteria
clinical Criteria
- Presence of open wound and displacement on imaging
Applicable To
- Open fracture of the proximal humerus
Excludes
- Pathological fracture (M84.52)
Clinical Validation Requirements
- X-ray or CT confirming displacement and open fracture
- Documentation of fracture location and type
Code-Specific Risks
- Misclassification if fracture type is not clearly documented
Coding Notes
- Ensure documentation specifies 'displaced' and 'open' to avoid unspecified coding.
S42.395D - Displaced fracture of shaft of left humerus, subsequent encounter for fracture with routine healing
Use for follow-up visits when the patient is healing from a displaced shaft fracture of the left humerus.
Applicable To
- Displaced shaft fracture of the humerus
Excludes
- Fracture-dislocation (S43.0-)
Clinical Validation Requirements
- Follow-up imaging showing healing progress
- Documentation of fracture type and healing status
Coding Notes
Ensure the encounter type is clearly documented to use the correct 7th character.
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 Humeral Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S42.292B.
Impact
Clinical: May lead to missed diagnosis of nerve injury, Regulatory: Non-compliance with documentation standards, Financial: Potential for denied claims
Mitigation Strategy
Use templates that prompt for neurovascular status, Educate staff on documentation importance
Impact
Reimbursement: May lead to lower reimbursement rates, Compliance: Increases risk of audit failures, Data Quality: Decreases accuracy of health records
Mitigation Strategy
Ensure documentation includes specific fracture details such as location and displacement.
Impact
High risk of audit if unspecified codes are used when specific details are available.
Mitigation Strategy
Ensure detailed documentation and use of specific 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 Humeral Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Humeral Fracture
Use these documentation templates to ensure complete and accurate documentation for Humeral Fracture. These templates include all required elements for proper coding and billing.
Initial Encounter for Displaced Humeral Fracture
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Fracture location and type
- Neurovascular status
- Imaging findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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