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ICD-10 Guide
ICD-10 CodesS42.295

S42.295

Billable

Other nondisplaced fracture of upper end of left humerus

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

Code Description

ICD-10 S42.295 is a billable code used to indicate a diagnosis of other nondisplaced fracture of upper end of left humerus.

Key Diagnostic Point:

The S42.295 code refers to a nondisplaced fracture of the upper end of the left humerus, which is a common injury often resulting from falls or direct trauma. Nondisplaced fractures are characterized by the bone being cracked or broken but remaining in alignment, which typically allows for a better prognosis and less invasive treatment options compared to displaced fractures. Clinically, patients may present with shoulder pain, swelling, and limited range of motion. Diagnosis is usually confirmed through imaging studies such as X-rays or MRI, which help to visualize the fracture and assess any associated soft tissue injuries, including rotator cuff tears. Treatment often involves conservative management, including immobilization with a sling, physical therapy, and pain management. In some cases, surgical intervention may be necessary, particularly if there is associated soft tissue damage or if conservative treatment fails to alleviate symptoms. Understanding the nuances of this code is essential for accurate billing and reimbursement, as well as for ensuring appropriate patient care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation between displaced and nondisplaced fractures
  • Need for precise documentation of fracture location
  • Potential for associated soft tissue injuries
  • Variability in treatment approaches

Audit Risk Factors

  • Inadequate documentation of fracture type
  • Failure to document associated injuries
  • Incorrect coding of fracture location
  • Lack of imaging reports in the medical record

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging results, and follow-up care plans.

Common Clinical Scenarios

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

Billing Considerations

Ensure that all associated injuries are documented, as they may affect treatment and coding.

Physical Therapy

Documentation Requirements

Initial evaluation notes, progress reports, and discharge summaries.

Common Clinical Scenarios

Rehabilitation following nondisplaced humeral fractures.

Billing Considerations

Documenting the patient's functional status and response to therapy is crucial for coding.

Coding Guidelines

Inclusion Criteria

Use S42.295 When
  • According to ICD
  • 10 guidelines, S42
  • 295 should be used when a nondisplaced fracture of the upper end of the left humerus is confirmed through imaging
  • It is important to document the specific location of the fracture and any associated injuries to ensure accurate coding

Exclusion Criteria

Do NOT use S42.295 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, surgical

Clinical Scenario

Used when a patient with a nondisplaced humeral fracture also has a rotator cuff repair.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should ensure that all relevant findings are documented.

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. S42.295 provides a clear distinction between nondisplaced and displaced fractures, which is crucial for treatment planning.

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. S42.295 provides a clear distinction between nondisplaced and displaced fractures, which is crucial for treatment planning.

Reimbursement & Billing Impact

reimbursement processes. S42.295 provides a clear distinction between nondisplaced and displaced fractures, which is crucial for treatment planning.

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 nondisplaced and displaced fracture?

A nondisplaced fracture means the bone is cracked but remains in alignment, while a displaced fracture involves the bone being misaligned.