ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesS42.231

S42.231

Billable

3-part fracture of surgical neck of right humerus

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/24/2025

Code Description

ICD-10 S42.231 is a billable code used to indicate a diagnosis of 3-part fracture of surgical neck of right humerus.

Key Diagnostic Point:

A 3-part fracture of the surgical neck of the right humerus typically occurs due to high-energy trauma, such as falls or sports injuries, particularly in older adults with osteoporotic bones. This type of fracture involves three distinct fragments: the greater tuberosity, the lesser tuberosity, and the humeral shaft. Clinically, patients present with significant shoulder pain, swelling, and limited range of motion. Diagnosis is confirmed through imaging studies, primarily X-rays, which reveal the fracture pattern and displacement. Treatment often involves surgical intervention, such as open reduction and internal fixation (ORIF), to restore anatomical alignment and function. Post-operative rehabilitation is crucial for regaining strength and mobility, and complications may include nonunion, malunion, or stiffness. Understanding the nuances of this fracture type is essential for accurate coding and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires knowledge of specific fracture types and their anatomical implications.
  • Involves understanding of surgical interventions and post-operative care.
  • Differentiation from other humeral fractures and dislocations.
  • Documentation must clearly specify the fracture type and location.

Audit Risk Factors

  • Inadequate documentation of fracture specifics.
  • Failure to document surgical interventions performed.
  • Misclassification of fracture type.
  • Incomplete follow-up documentation post-surgery.

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and post-operative notes are essential.

Common Clinical Scenarios

Fractures due to falls, sports injuries, or pathological fractures in osteoporotic patients.

Billing Considerations

Ensure that all fracture fragments and surgical techniques are documented to support coding.

Physical Therapy

Documentation Requirements

Progress notes detailing rehabilitation goals, treatment modalities, and patient response.

Common Clinical Scenarios

Rehabilitation following surgical repair of humeral fractures.

Billing Considerations

Documenting functional limitations and progress is crucial for coding therapy sessions.

Coding Guidelines

Inclusion Criteria

Use S42.231 When
  • Follow ICD
  • CM guidelines for coding fractures, including the need for specificity regarding the fracture type, location, and any associated complications
  • Ensure compliance with documentation standards for surgical procedures

Exclusion Criteria

Do NOT use S42.231 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23630CPT Code

Open treatment of humeral head fracture

Clinical Scenario

Used in conjunction with S42.231 for surgical repair.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the fracture type and surgical approach.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding fractures, improving the accuracy of patient records and billing. S42.231 provides detailed information that can impact treatment plans and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding fractures, improving the accuracy of patient records and billing. S42.231 provides detailed information that can impact treatment plans and reimbursement.

Reimbursement & Billing Impact

billing. S42.231 provides detailed information that can impact treatment plans and reimbursement.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between a 2-part and a 3-part fracture of the surgical neck of the humerus?

A 2-part fracture involves two fragments, typically the humeral head and the shaft, while a 3-part fracture includes additional fragments, such as the greater and lesser tuberosities, indicating a more complex injury.