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S42.309A
ICD-10-CM
Humerus Fracture

Find information on Humerus Fracture diagnosis, including clinical documentation requirements, ICD-10 codes (S42), medical coding guidelines, and healthcare best practices for proper diagnosis and treatment. Learn about different types of humerus fractures, such as proximal, distal, and shaft fractures, and explore relevant medical terminology for accurate coding and documentation in healthcare settings. This resource provides valuable insights for physicians, coders, and other healthcare professionals dealing with humerus fracture cases.

Also known as

Upper Arm Fracture
Humeral Fracture

Diagnosis Snapshot

Key Facts
  • Definition : Break in the upper arm bone.
  • Clinical Signs : Pain, swelling, bruising, deformity, limited arm movement.
  • Common Settings : Falls, sports injuries, trauma.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC S42.309A Coding
S42.2–S42.4

Fracture of upper end of humerus

Fractures involving the proximal humerus, including anatomical neck and surgical neck.

S42.3–S42.3

Surgical neck of humerus fracture

Fracture specifically at the surgical neck of the humerus.

S42.4–S42.4

Greater tuberosity fracture

Fracture involving the greater tuberosity of the humerus.

S42.5–S42.7

Shaft/lower end humerus fx

Fractures of the humeral shaft or distal end.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the fracture traumatic?

  • Yes

    Open or closed fracture?

  • No

    Pathological fracture?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Humerus Fracture
Proximal Humerus Fracture
Humeral Shaft Fracture

Documentation Best Practices

Documentation Checklist
  • Humerus fracture diagnosis code
  • Laterality (right or left humerus)
  • Fracture type (e.g., displaced, comminuted)
  • Location of fracture (e.g., proximal, shaft)
  • Associated injuries documented

Coding and Audit Risks

Common Risks
  • Unspecified Fracture Site

    Coding humerus fractures without laterality or specific location (e.g., proximal, shaft, distal) leads to inaccurate claims and potential denials. CDI crucial.

  • Open vs. Closed Fracture

    Miscoding open fractures as closed or vice versa significantly impacts reimbursement. Proper documentation and coding audits are essential for compliance.

  • Associated Injuries

    Failing to code associated injuries like nerve damage or vascular compromise with humerus fractures leads to underreporting severity and lost revenue.

Mitigation Tips

Best Practices
  • Document fracture type, location, laterality using ICD-10-CM guidelines for accurate coding.
  • Ensure CDI aligns documentation with clinical findings for proper HCC risk adjustment.
  • Query physician for clarification on unspecified fractures to improve coding specificity.
  • Validate external cause codes (E-codes) for injury documentation compliance.
  • Regularly audit humerus fracture documentation for coding accuracy and compliance.

Clinical Decision Support

Checklist
  • Verify mechanism of injury documented (ICD-10 S42, W00-W19)
  • Confirm physical exam findings: pain, deformity, swelling
  • Check imaging results: X-ray, CT scan for fracture confirmation
  • Document fracture type and location for accurate coding (AO/OTA)

Reimbursement and Quality Metrics

Impact Summary
  • Humerus Fracture Reimbursement: Coding accuracy impacts payment. Proper ICD-10 (S42) and CPT codes are crucial for maximizing reimbursement and avoiding denials. Key factors include fracture type, treatment (surgical vs. non-surgical), and associated injuries.
  • Quality Metrics Impact: Accurate documentation of Humerus Fracture diagnosis (S42) affects hospital quality reporting. Metrics like time to treatment, pain management, and functional outcomes are influenced by coding specificity.
  • Complication Reporting: Coding for complications (e.g., nerve damage, infection) directly impacts hospital reimbursement and quality scores. Accurate coding reflects the severity of the case and resource utilization.
  • Denial Management: Incorrect or incomplete coding for Humerus Fracture leads to claim denials and rework. Thorough documentation and specific coding (open vs. closed, displaced vs. non-displaced) are key for successful claims.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes for . Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code fracture type, laterality
  • ICD-10 S42.X, specify site
  • Document mechanism of injury
  • X-ray confirmation vital
  • Check 7th character guidance

Documentation Templates

Patient presents with complaints consistent with humerus fracture.  Symptoms include pain, swelling, and limited range of motion in the affected arm.  Onset of symptoms followed [Mechanism of injury - e.g., fall, direct blow, sporting injury].  Physical examination reveals point tenderness, ecchymosis, and crepitus over the [Location of fracture - e.g., proximal, midshaft, distal] humerus.  Neurovascular status of the hand and distal extremity was assessed and found to be [Intact or describe deficit].  Radiographic imaging of the humerus confirmed a [Type of fracture - e.g., transverse, oblique, spiral, comminuted, impacted] fracture of the [Specific bone location - e.g., surgical neck, humeral shaft, distal condyle] with [Degree of displacement - e.g., nondisplaced, minimally displaced, significantly displaced].  Differential diagnosis considered included contusion, shoulder dislocation, and rotator cuff tear.  Diagnosis of humerus fracture was established based on clinical findings and radiographic evidence.  Treatment plan includes [Conservative or surgical - e.g., closed reduction, open reduction internal fixation, external fixation] and pain management with [Analgesic - e.g., ibuprofen, acetaminophen, opioid medications if necessary].  Patient education provided on fracture care, immobilization, and follow-up appointments.  Referral to orthopedics for further evaluation and management.  ICD-10 code S42 [Add specific code based on location and type of fracture] is assigned.  Return to clinic scheduled in [Timeframe] for follow-up and reassessment.  Prognosis for healing is [Good, fair, guarded] depending on fracture severity and patient compliance with treatment.