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ICD-10 Guide
ICD-10 CodesS42.24

S42.24

Billable

4-part fracture of surgical neck of humerus

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

Code Description

ICD-10 S42.24 is a billable code used to indicate a diagnosis of 4-part fracture of surgical neck of humerus.

Key Diagnostic Point:

A 4-part fracture of the surgical neck of the humerus is a complex injury that typically occurs due to high-energy trauma, such as falls or motor vehicle accidents. This type of fracture involves four distinct fragments of the humerus, which can complicate the healing process and may require surgical intervention. The surgical neck is located just below the head of the humerus and is a common site for fractures, particularly in older adults with osteoporosis. Symptoms include severe shoulder pain, swelling, and limited range of motion. Diagnosis is confirmed through physical examination and imaging studies, such as X-rays or CT scans. Treatment options vary based on the severity of the fracture and may include conservative management with immobilization or surgical repair, such as open reduction and internal fixation (ORIF). Rehabilitation is crucial for restoring function and strength in the shoulder joint following treatment.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires detailed documentation of fracture type and location.
  • Involves understanding of surgical interventions and their coding.
  • Potential for multiple associated injuries complicating coding.
  • Need for accurate assessment of the patient's age and bone health.

Audit Risk Factors

  • Inadequate documentation of fracture details.
  • Failure to capture associated injuries.
  • Incorrect coding of surgical procedures performed.
  • Lack of clarity in the treatment plan.

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging reports, and follow-up assessments.

Common Clinical Scenarios

Surgical repair of complex humeral fractures, post-operative care, and rehabilitation.

Billing Considerations

Ensure accurate coding of surgical techniques and any complications.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive evaluation of functional status and rehabilitation progress.

Common Clinical Scenarios

Rehabilitation following surgical repair of shoulder fractures.

Billing Considerations

Focus on functional outcomes and therapy interventions.

Coding Guidelines

Inclusion Criteria

Use S42.24 When
  • Follow official ICD
  • CM coding guidelines, ensuring accurate documentation of fracture type, treatment provided, and any associated conditions
  • Include details on the mechanism of injury and patient demographics

Exclusion Criteria

Do NOT use S42.24 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23630CPT Code

Open treatment of humeral head fracture

Clinical Scenario

Used when surgical intervention is performed for a 4-part fracture.

Documentation Requirements

Operative report detailing the procedure and any complications.

Specialty Considerations

Orthopedic surgeons must document the specifics of the fracture and repair.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, including the 4-part fracture of the surgical neck of the humerus, which enhances data accuracy and improves patient care tracking.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including the 4-part fracture of the surgical neck of the humerus, which enhances data accuracy and improves patient care tracking.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fractures, including the 4-part fracture of the surgical neck of the humerus, which enhances data accuracy and improves patient care tracking.

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 significance of a 4-part fracture of the surgical neck of the humerus?

A 4-part fracture indicates a more complex injury that may require surgical intervention and has a higher risk of complications, such as avascular necrosis.