ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesS42.293

S42.293

Billable

Other displaced fracture of upper end of unspecified humerus

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

Code Description

ICD-10 S42.293 is a billable code used to indicate a diagnosis of other displaced fracture of upper end of unspecified humerus.

Key Diagnostic Point:

The S42.293 code refers to a specific type of fracture occurring at the upper end of the 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 result from various mechanisms, including falls, direct trauma, or sports injuries. Patients may present with significant pain, swelling, and limited range of motion in the shoulder. The upper end of the humerus is critical for shoulder function, and fractures in this area can lead to complications such as rotator cuff injuries or shoulder dislocations. Treatment often involves orthopedic surgical repairs, which may include internal fixation or shoulder arthroplasty, depending on the fracture's severity and the patient's overall health. Accurate coding is essential for proper reimbursement and to ensure that the patient's medical history reflects the complexity of their injury and treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and locations within the humerus
  • Need for precise documentation of displacement and associated injuries
  • Potential for co-existing conditions such as rotator cuff tears
  • Variations in treatment approaches and surgical interventions

Audit Risk Factors

  • Inadequate documentation of fracture details
  • Failure to document associated injuries like rotator cuff tears
  • Incorrect coding of fracture type or location
  • Lack of clarity on treatment provided

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

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

Billing Considerations

Ensure documentation specifies the type of fracture, displacement, and any associated injuries.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation plans.

Common Clinical Scenarios

Patients recovering from humeral fractures undergoing physical therapy.

Billing Considerations

Document progress and any complications that may arise during rehabilitation.

Coding Guidelines

Inclusion Criteria

Use S42.293 When
  • Follow official ICD
  • 10 coding guidelines, ensuring that the fracture is documented as displaced and specifying the location as 'upper end of unspecified humerus
  • displaced fractures or fractures of other locations

Exclusion Criteria

Do NOT use S42.293 When
  • ' Exclude codes for non

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopic rotator cuff repair

Clinical Scenario

Used when a rotator cuff injury is identified during surgery for a humeral fracture.

Documentation Requirements

Operative report detailing the findings and procedures performed.

Specialty Considerations

Orthopedic surgeons must document the relationship between the fracture and any rotator cuff repairs.

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 reimbursement processes. S42.293 provides a clear distinction for displaced fractures, which is critical for treatment planning and outcome tracking.

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 reimbursement processes. S42.293 provides a clear distinction for displaced fractures, which is critical for treatment planning and outcome tracking.

Reimbursement & Billing Impact

reimbursement processes. S42.293 provides a clear distinction for displaced fractures, which is critical for treatment planning and outcome tracking.

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 S42.293 and S42.291?

S42.293 refers to other displaced fractures of the upper end of the humerus, while S42.291 specifically denotes a displaced fracture of the surgical neck of the humerus. Accurate coding depends on the specific fracture location and type.