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ICD-10 Guide
ICD-10 CodesS42.271

S42.271

Billable

Torus fracture of upper end of right humerus

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

Code Description

ICD-10 S42.271 is a billable code used to indicate a diagnosis of torus fracture of upper end of right humerus.

Key Diagnostic Point:

A torus fracture, also known as a buckle fracture, is a common type of fracture seen in children, characterized by a compression of the bone that results in a bulging or buckling of the cortex without a complete break. In the case of the upper end of the right humerus, this injury typically occurs due to a fall or direct impact, often during sports or play. The upper end of the humerus is crucial for shoulder function, as it articulates with the scapula to form the shoulder joint. While torus fractures are generally less severe than complete fractures, they can still lead to pain, swelling, and limited range of motion in the shoulder. Diagnosis is usually confirmed through X-ray imaging, which reveals the characteristic buckling of the bone. Treatment often involves immobilization with a splint or cast, and in some cases, physical therapy may be required to restore full function. Understanding the implications of this fracture is essential for proper management and coding, as it can impact the patient's recovery and rehabilitation process.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between torus and complete fractures
  • Understanding the anatomical location and implications for treatment
  • Variability in documentation practices among providers
  • Potential for associated injuries in the shoulder region

Audit Risk Factors

  • Inadequate documentation of the fracture type
  • Failure to specify laterality (right vs. left)
  • Misclassification of fracture severity
  • Lack of imaging reports to support diagnosis

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes including mechanism of injury, imaging results, and treatment plan.

Common Clinical Scenarios

Fractures resulting from falls, sports injuries, or accidents in pediatric patients.

Billing Considerations

Ensure accurate description of fracture type and location to avoid miscoding.

Pediatrics

Documentation Requirements

Comprehensive history and physical examination notes, including developmental milestones.

Common Clinical Scenarios

Children presenting with arm pain after a fall, requiring evaluation for potential fractures.

Billing Considerations

Consider age-related factors in fracture healing and treatment options.

Coding Guidelines

Inclusion Criteria

Use S42.271 When
  • Follow the official ICD
  • CM coding guidelines, ensuring to document the specific type of fracture, laterality, and any associated injuries
  • Include imaging results and treatment plans in the medical record

Exclusion Criteria

Do NOT use S42.271 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

CPT 25600CPT Code

Closed treatment of humeral shaft fracture

Clinical Scenario

Used when a torus fracture requires manipulation or stabilization.

Documentation Requirements

Document the procedure performed, including any imaging and follow-up care.

Specialty Considerations

Orthopedic specialists should ensure accurate coding based on the type of 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 torus 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 torus fractures, 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 torus fractures, 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 a torus fracture?

A torus fracture is a type of bone fracture that occurs when one side of the bone buckles without breaking all the way through. It is most commonly seen in children due to the flexibility of their bones.