ICD-10 Coding for Right Elbow Fracture(S42.401A, S42.411A)
Complete ICD-10-CM coding and documentation guide for Right Elbow Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Elbow Fracture
S42.4Primary Range
Fracture of lower end of humerus
This range includes all fractures of the lower end of the humerus, including supracondylar and condylar fractures, which are common in elbow injuries.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S42.401A | Unspecified fracture of lower end of right humerus, initial encounter | Use when the specific type of fracture (e.g., supracondylar, condylar) is not documented. |
|
| S42.411A | Displaced simple supracondylar fracture without intercondylar fracture of right humerus, initial encounter | Use when imaging confirms a displaced supracondylar fracture. |
|
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 elbow fracture
Essential facts and insights about Right Elbow Fracture
Primary ICD-10-CM Codes for right elbow fracture
Decision Criteria
documentation Criteria
- Fracture type and laterality must be specified.
Applicable To
- Closed fracture of right elbow
Excludes
- Open fracture of right elbow
Clinical Validation Requirements
- X-ray showing fracture at the lower end of the right humerus
- Clinical examination confirming fracture symptoms
Code-Specific Risks
- Risk of under-documentation leading to unspecified coding
Coding Notes
- Ensure laterality and encounter type are documented.
S42.411A - Displaced simple supracondylar fracture without intercondylar fracture of right humerus, initial encounter
Use when imaging confirms a displaced supracondylar fracture.
Applicable To
- Displaced supracondylar fracture of right humerus
Excludes
- Nondisplaced supracondylar fracture
Clinical Validation Requirements
- X-ray showing displaced fracture at the supracondylar region
- Clinical examination confirming displacement
Coding Notes
Ensure displacement and fracture type are documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Right Elbow Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S42.401A.
Impact
Clinical: Leads to ambiguity in patient records., Regulatory: Non-compliance with ICD-10 coding rules., Financial: Potential for denied claims.
Mitigation Strategy
Always document 'right' or 'left' for elbow fractures., Use templates that prompt for laterality.
Impact
Reimbursement: May lead to incorrect billing and reimbursement., Compliance: Non-compliance with coding standards., Data Quality: Decreases accuracy of medical records.
Mitigation Strategy
Always document the specific type and displacement status of the fracture.
Impact
Risk of audits due to missing fracture specifics.
Mitigation Strategy
Implement thorough documentation practices.
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 Elbow Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Elbow Fracture
Use these documentation templates to ensure complete and accurate documentation for Right Elbow Fracture. These templates include all required elements for proper coding and billing.
Initial Emergency Department Visit
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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