ICD-10 Coding for Left Shoulder Fracture(S42.202A, S42.292A)
Complete ICD-10-CM coding and documentation guide for Left Shoulder Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Left Shoulder Fracture
S42.2-S42.3Primary Range
Fractures of shoulder and upper arm
This range includes specific codes for fractures of the proximal humerus, which is the most common site for left shoulder 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 |
|---|---|---|---|
| S42.202A | Unspecified fracture of upper end of left humerus, initial encounter for closed fracture | Use for initial encounters where the fracture type is unspecified but confirmed as closed. |
|
| S42.292A | Displaced fracture of upper end of left humerus, initial encounter for closed fracture | Use when the fracture is confirmed as displaced. |
|
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 left shoulder fracture
Essential facts and insights about Left Shoulder Fracture
Primary ICD-10-CM Codes for left shoulder fracture
Decision Criteria
documentation Criteria
- Document the fracture as closed and specify the encounter type.
Applicable To
- Closed fracture of upper end of left humerus
Clinical Validation Requirements
- X-ray confirmation of fracture at the upper end of the left humerus
- Documentation of closed fracture status
Code-Specific Risks
- Risk of using this code without specifying the fracture type can lead to incorrect billing.
Coding Notes
- Ensure laterality and encounter type are documented to avoid unspecified coding.
S42.292A - Displaced fracture of upper end of left humerus, initial encounter for closed fracture
Use when the fracture is confirmed as displaced.
Applicable To
- Displaced fracture of surgical neck of left humerus
Excludes
- Fracture of scapula (S42.1-)
- Fracture of clavicle (S42.0-)
Clinical Validation Requirements
- X-ray showing displacement of fracture fragments
- Documentation of closed fracture status
Coding Notes
Ensure displacement is clearly documented to avoid defaulting to unspecified.
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.
Other fracture of upper end of left humerus, initial encounter for closed fracture
S42.291ANondisplaced fracture of upper end of left humerus, initial encounter for closed fracture
S42.295ADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Left Shoulder 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: Inaccurate treatment records., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always include encounter type in documentation., Use templates that prompt for encounter details.
Impact
Reimbursement: May lead to denied claims or reduced reimbursement., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Always document the specific part of the humerus and the encounter type.
Impact
Failure to document laterality can lead to audit flags.
Mitigation Strategy
Implement mandatory fields for laterality 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 Left Shoulder Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Left Shoulder Fracture
Use these documentation templates to ensure complete and accurate documentation for Left Shoulder Fracture. These templates include all required elements for proper coding and billing.
Initial ED Visit for Left Shoulder Fracture
Specialty: Emergency MedicineRequired Elements
- Mechanism of injury
- Physical exam findings
- Imaging results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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