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ICD-10 Guide
ICD-10 CodesS42.25

S42.25

Billable

Fracture of greater tuberosity of humerus

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

Code Description

ICD-10 S42.25 is a billable code used to indicate a diagnosis of fracture of greater tuberosity of humerus.

Key Diagnostic Point:

The greater tuberosity of the humerus is a critical anatomical structure that serves as an attachment point for the rotator cuff muscles, which are essential for shoulder stability and movement. A fracture of the greater tuberosity typically occurs due to trauma, such as a fall or direct impact, and can significantly affect shoulder function. Patients may present with shoulder pain, swelling, and limited range of motion. Diagnosis is often confirmed through imaging studies, such as X-rays or MRI, which can reveal the extent of the fracture and any associated injuries to the rotator cuff. Treatment may vary based on the severity of the fracture and the patient's overall health, ranging from conservative management with physical therapy to surgical intervention for more complex cases. Surgical options may include open reduction and internal fixation (ORIF) to stabilize the fracture and restore function. Rehabilitation is crucial post-surgery to regain strength and mobility, and to prevent complications such as stiffness or re-injury.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture severity and treatment options
  • Potential for associated rotator cuff injuries
  • Need for precise documentation of imaging findings
  • Variations in surgical procedures and techniques

Audit Risk Factors

  • Inadequate documentation of fracture type and location
  • Failure to document associated injuries
  • Incorrect coding of surgical procedures
  • Lack of follow-up documentation post-treatment

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and pre/post-operative assessments are essential.

Common Clinical Scenarios

Fractures resulting from falls, sports injuries, or accidents requiring surgical intervention.

Billing Considerations

Ensure accurate coding of any associated rotator cuff repairs or other shoulder procedures performed concurrently.

Physical Therapy

Documentation Requirements

Progress notes detailing range of motion, strength assessments, and rehabilitation protocols.

Common Clinical Scenarios

Patients undergoing rehabilitation post-fracture or surgery to restore shoulder function.

Billing Considerations

Documenting the patient's response to therapy and any complications that arise during treatment.

Coding Guidelines

Inclusion Criteria

Use S42.25 When
  • According to ICD
  • 10 guidelines, S42
  • 25 should be used when the fracture is specifically identified as involving the greater tuberosity
  • Coders must ensure that the documentation supports the diagnosis and that any associated conditions are also coded appropriately

Exclusion Criteria

Do NOT use S42.25 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopic repair of rotator cuff

Clinical Scenario

Used when a rotator cuff repair is performed alongside greater tuberosity fracture fixation.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the extent of the rotator cuff injury.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of shoulder injuries, including fractures of the greater tuberosity, which enhances the accuracy of patient records and treatment plans.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of shoulder injuries, including fractures of the greater tuberosity, which enhances the accuracy of patient records and treatment plans.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of shoulder injuries, including fractures of the greater tuberosity, which enhances the accuracy of patient records and treatment plans.

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 primary cause of a greater tuberosity fracture?

The primary cause is typically trauma, such as falls or sports injuries, which can lead to direct impact on the shoulder.