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ICD-10 Guide
ICD-10 CodesS42.256

S42.256

Billable

Nondisplaced fracture of greater tuberosity of unspecified humerus

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

Code Description

ICD-10 S42.256 is a billable code used to indicate a diagnosis of nondisplaced fracture of greater tuberosity of unspecified humerus.

Key Diagnostic Point:

A nondisplaced fracture of the greater tuberosity of the humerus is a common injury that typically occurs due to falls or direct trauma to the shoulder. The greater tuberosity is a bony prominence on the humerus where rotator cuff muscles attach, making this type of fracture significant in terms of shoulder function and mobility. Patients may present with shoulder pain, swelling, and limited range of motion. Diagnosis is usually confirmed through physical examination and imaging studies such as X-rays or MRI. Treatment often involves conservative management, including rest, ice, and physical therapy, although surgical intervention may be necessary in cases where the fracture affects the stability of the shoulder or the function of the rotator cuff. Understanding the implications of this fracture is crucial for effective rehabilitation and recovery, as it can impact the patient's ability to perform daily activities and may lead to complications if not managed properly.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Understanding the anatomical significance of the greater tuberosity
  • Identifying associated injuries such as rotator cuff tears
  • Variability in treatment approaches based on patient age and activity level

Audit Risk Factors

  • Inadequate documentation of fracture type and location
  • Failure to document associated injuries or complications
  • Misclassification of fracture displacement
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

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

Billing Considerations

Ensure accurate coding of any surgical procedures performed, including fixation or repair of associated rotator cuff injuries.

Physical Therapy

Documentation Requirements

Initial evaluation notes, progress reports, and discharge summaries.

Common Clinical Scenarios

Rehabilitation following nondisplaced fractures and rotator cuff injuries.

Billing Considerations

Document functional limitations and progress towards rehabilitation goals.

Coding Guidelines

Inclusion Criteria

Use S42.256 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the fracture type, location, and any associated injuries
  • Include details from imaging studies and clinical assessments to support the diagnosis

Exclusion Criteria

Do NOT use S42.256 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopic rotator cuff repair

Clinical Scenario

Used when surgical intervention is required for associated rotator cuff injuries.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should document the extent of the injury and any repairs performed.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of patient records and facilitating better treatment planning. S42.256 provides a clear distinction between nondisplaced and displaced fractures, which is essential for appropriate management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of patient records and facilitating better treatment planning. S42.256 provides a clear distinction between nondisplaced and displaced fractures, which is essential for appropriate management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of patient records and facilitating better treatment planning. S42.256 provides a clear distinction between nondisplaced and displaced fractures, which is essential for appropriate management.

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 coding S42.256 accurately?

Accurate coding of S42.256 is crucial for proper treatment planning, reimbursement, and tracking patient outcomes. It ensures that healthcare providers can effectively manage the patient's recovery and address any complications that may arise.