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ICD-10 Guide
ICD-10 CodesS42.264

S42.264

Billable

Nondisplaced fracture of lesser tuberosity of right humerus

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

Code Description

ICD-10 S42.264 is a billable code used to indicate a diagnosis of nondisplaced fracture of lesser tuberosity of right humerus.

Key Diagnostic Point:

A nondisplaced fracture of the lesser tuberosity of the right humerus typically occurs due to trauma, such as a fall or direct impact to the shoulder. The lesser tuberosity serves as an attachment point for the subscapularis muscle, which is crucial for shoulder stability and function. In this type of fracture, the bone fragments remain in their normal anatomical position, which often allows for conservative management without the need for surgical intervention. Symptoms may include localized pain, swelling, and limited range of motion in the shoulder. Diagnosis is usually confirmed through imaging studies, such as X-rays or MRI, which can help assess the extent of the injury and rule out associated injuries, such as rotator cuff tears or dislocations. Treatment typically involves rest, immobilization, and physical therapy to restore function and strength. In some cases, if conservative management fails, surgical options may be considered to repair the fracture or address any associated injuries.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Understanding associated injuries such as rotator cuff tears
  • Documentation of specific anatomical locations
  • Variability in treatment approaches based on patient age and activity level

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to document associated injuries
  • Misclassification of fracture type (displaced vs. nondisplaced)
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

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

Billing Considerations

Ensure accurate documentation of fracture type and any surgical repairs performed.

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 S42.264 When
  • According to ICD
  • 10 coding guidelines, S42
  • 264 should be used when the fracture is confirmed as nondisplaced and specifically located at the lesser tuberosity of the right humerus
  • Coders should ensure that the documentation supports the diagnosis and that any associated injuries are also coded appropriately

Exclusion Criteria

Do NOT use S42.264 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 tear is identified during surgery for a fracture.

Documentation Requirements

Operative report detailing the findings and procedures performed.

Specialty Considerations

Orthopedic surgeons should ensure that the rotator cuff injury is documented as related to the fracture.

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 differentiate between displaced and nondisplaced fractures, 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 differentiate between displaced and nondisplaced fractures, which enhances the accuracy of patient records and treatment plans.

Reimbursement & Billing Impact

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 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 normal position.