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ICD-10 Guide
ICD-10 CodesS42.272

S42.272

Billable

Torus fracture of upper end of left humerus

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

Code Description

ICD-10 S42.272 is a billable code used to indicate a diagnosis of torus fracture of upper end of left humerus.

Key Diagnostic Point:

A torus fracture, also known as a buckle fracture, is a common type of injury in children, characterized by a compression of the bone that causes it to bulge or buckle without breaking completely. In the case of the upper end of the left humerus, this type of fracture 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. Symptoms may include localized pain, swelling, and limited range of motion in the shoulder. Diagnosis is usually confirmed through X-ray imaging, which will show the characteristic buckling of the bone. Treatment often involves immobilization with a splint or cast, and in some cases, physical therapy may be recommended to restore function. While torus fractures generally have a good prognosis, proper coding is essential to ensure accurate billing and to reflect the nature of the injury for treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of humeral fractures
  • Understanding the implications of the fracture location
  • Documentation of associated injuries or conditions
  • Variability in treatment approaches based on patient age

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify laterality (left vs. right)
  • Misclassification of fracture type
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed description of the fracture type, location, and treatment plan.

Common Clinical Scenarios

Fractures resulting from falls, sports injuries, or accidents.

Billing Considerations

Ensure accurate documentation of any surgical interventions or follow-up care.

Pediatrics

Documentation Requirements

Age of the patient, mechanism of injury, and any developmental considerations.

Common Clinical Scenarios

Common in children due to falls during play or sports.

Billing Considerations

Consideration of growth plate involvement and potential for future complications.

Coding Guidelines

Inclusion Criteria

Use S42.272 When
  • Follow the official ICD
  • CM coding guidelines, ensuring to document the specific type of fracture and any associated injuries
  • Include laterality and specify if the fracture is closed or open

Exclusion Criteria

Do NOT use S42.272 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23630CPT Code

Closed treatment of humeral fracture

Clinical Scenario

Used when a torus fracture is treated without surgical intervention.

Documentation Requirements

Document the type of fracture and treatment provided.

Specialty Considerations

Orthopedic specialists should ensure accurate coding based on the treatment approach.

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 ability to track and manage these injuries effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including torus fractures, which enhances the ability to track and manage these injuries effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fractures, including torus fractures, which enhances the ability to track and manage these injuries effectively.

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 completely, commonly seen in children.