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ICD-10 Guide
ICD-10 CodesS42.291

S42.291

Billable

Other displaced fracture of upper end of right humerus

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

Code Description

ICD-10 S42.291 is a billable code used to indicate a diagnosis of other displaced fracture of upper end of right humerus.

Key Diagnostic Point:

The S42.291 code refers to a specific type of fracture occurring at the upper end of the right humerus, which is the long bone of the upper arm. This fracture is classified as 'displaced,' meaning that the bone fragments have moved out of their normal alignment. Such fractures can occur due to trauma, such as falls or direct blows, and are often associated with shoulder dislocations or rotator cuff injuries. Patients may present with severe pain, swelling, and limited range of motion in the shoulder. Diagnosis typically involves physical examination and imaging studies, such as X-rays or MRI, to assess the extent of the fracture and any associated soft tissue injuries. Treatment may vary from conservative management, including immobilization and physical therapy, to surgical interventions like open reduction and internal fixation (ORIF) to realign and stabilize the bone. Understanding the nuances of this code is essential for accurate billing and ensuring appropriate care pathways are followed.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between types of humeral fractures
  • Identifying associated injuries (e.g., rotator cuff tears)
  • Understanding the implications of 'displaced' versus 'non-displaced' fractures
  • Variability in treatment approaches (surgical vs. conservative)

Audit Risk Factors

  • Inadequate documentation of fracture type and displacement
  • Failure to document associated injuries or conditions
  • Incorrect coding of laterality (right vs. left)
  • Lack of clarity in treatment plans (surgical vs. non-surgical)

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and follow-up notes are essential for accurate coding.

Common Clinical Scenarios

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

Billing Considerations

Ensure that all surgical procedures are documented, including any complications or additional procedures performed.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation plans.

Common Clinical Scenarios

Patients undergoing rehabilitation post-fracture or surgery to restore shoulder function.

Billing Considerations

Documenting progress and response to therapy is crucial for ongoing coding and billing.

Coding Guidelines

Inclusion Criteria

Use S42.291 When
  • According to ICD
  • 10 coding guidelines, S42
  • 291 should be used when a patient presents with a displaced fracture of the upper end of the right humerus
  • Coders must ensure that the documentation supports the diagnosis and that all relevant details are captured, including laterality and displacement

Exclusion Criteria

Do NOT use S42.291 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23615CPT Code

Open treatment of humeral head fracture

Clinical Scenario

Used when surgical intervention is required for a displaced humeral fracture.

Documentation Requirements

Operative report detailing the procedure, indications, and post-operative care.

Specialty Considerations

Orthopedic surgeons must ensure that all aspects of the surgery are documented for accurate coding.

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 laterality and displacement, which enhances the accuracy of patient records and billing processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including laterality and displacement, which enhances the accuracy of patient records and billing processes.

Reimbursement & Billing Impact

billing processes.

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 displaced and non-displaced fractures?

Displaced fractures involve a separation of bone fragments, while non-displaced fractures maintain alignment. Accurate coding depends on identifying the type of fracture.