Injuries to the shoulder and upper arm

Historical Changes

• •FY 2025: Routine maintenance updates with minor terminology clarifications
• •FY 2024: Enhanced specificity requirements for certain code ranges
• •FY 2023: Updated documentation guidelines for improved clarity

Upcoming Changes

• •Proposed updates pending review by Coordination and Maintenance Committee
• •Under consideration: Enhanced digital health integration codes

Implementation Guidance

• •Review all FY 2026 updates for S80-S89 codes before implementation
• •Always verify the most current codes in the ICD-10-CM manual
• •Ensure clinical documentation supports the selected diagnosis codes
• +3 more guidance items...

Key Usage Points:

• •Always code the injury to the highest level of specificity.
• •Use additional codes to identify any associated injuries.
• •Use a code from category S80-S89 for both initial and subsequent encounters.
• •For fractures, use a seventh character to indicate the type of encounter and healing status.
• •For injuries that involve multiple regions, use additional codes as necessary.

When to Use:

• ✓When documenting a fracture of the humerus.
• ✓When coding for a dislocation of the shoulder joint.
• ✓When documenting a sprain of the elbow.
• ✓When coding for an open wound of the upper arm.
• ✓When documenting a crush injury of the shoulder.

When NOT to Use:

• ✗When the injury is located on the lower arm or hand.
• ✗When the injury is a burn or corrosion.
• ✗When the injury is a complication of surgical and medical care.
• ✗When the injury is due to child or adult abuse.

Common Documentation Errors:

• ⚠Not specifying the location of the injury
• ⚠Not indicating the encounter type
• ⚠Not documenting associated injuries
• ⚠Not indicating the healing status for fractures