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ICD-10 Guide
ICD-10 CodesS42.254

S42.254

Billable

Nondisplaced fracture of greater tuberosity of right humerus

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

Code Description

ICD-10 S42.254 is a billable code used to indicate a diagnosis of nondisplaced fracture of greater tuberosity of right humerus.

Key Diagnostic Point:

A nondisplaced fracture of the greater tuberosity of the right humerus typically occurs due to trauma, such as a fall or direct impact to the shoulder. The greater tuberosity is a bony prominence on the humerus where rotator cuff muscles attach, making this type of fracture significant for 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 fracture's location and assess for any associated soft tissue injuries. Treatment usually involves conservative management, including rest, ice, and physical therapy, although surgical intervention may be necessary if the fracture is associated with significant displacement or if there are concurrent rotator cuff injuries. Understanding the implications of this fracture is crucial, as it can affect the patient's shoulder stability and function, potentially leading to long-term complications if not managed appropriately.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Understanding associated soft tissue injuries
  • Documentation of specific anatomical locations
  • Variability in treatment approaches

Audit Risk Factors

  • Inadequate documentation of fracture type
  • Failure to document associated injuries
  • Misclassification of fracture displacement
  • Inconsistent treatment documentation

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed imaging reports, surgical notes if applicable, and follow-up assessments.

Common Clinical Scenarios

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

Billing Considerations

Ensure documentation reflects the nondisplaced nature and any associated soft tissue injuries.

Physical Therapy

Documentation Requirements

Progress notes detailing range of motion, strength assessments, and treatment plans.

Common Clinical Scenarios

Rehabilitation following a nondisplaced fracture to restore shoulder function.

Billing Considerations

Documenting the patient's response to therapy and any changes in treatment plans.

Coding Guidelines

Inclusion Criteria

Use S42.254 When
  • According to ICD
  • 10 guidelines, S42
  • 254 should be used when the fracture is confirmed as nondisplaced and specifically located at the greater tuberosity of the right humerus
  • It is essential to document the mechanism of injury and any associated conditions

Exclusion Criteria

Do NOT use S42.254 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23410CPT Code

Repair of rotator cuff

Clinical Scenario

Used when a rotator cuff repair is performed alongside fracture management.

Documentation Requirements

Surgical notes detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should document the relationship between the fracture and any rotator cuff repairs.

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 ability to denote laterality and displacement status, 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 fractures, including the ability to denote laterality and displacement status, 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 fractures, including the ability to denote laterality and displacement status, 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 difference between a displaced and nondisplaced fracture?

A displaced fracture involves a break in the bone where the ends are not aligned, while a nondisplaced fracture means the bone cracks but maintains its proper alignment.