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ICD-10 Guide
ICD-10 CodesS42.3

S42.3

Billable

Fracture of shaft of humerus

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

Code Description

ICD-10 S42.3 is a billable code used to indicate a diagnosis of fracture of shaft of humerus.

Key Diagnostic Point:

A fracture of the shaft of the humerus is a common injury that typically occurs due to trauma, such as falls, direct blows, or accidents. This type of fracture can be classified as either a closed or open fracture, depending on whether the skin is broken. Patients may present with significant pain, swelling, and limited range of motion in the shoulder and arm. The fracture may also lead to complications such as nerve injury, particularly to the radial nerve, which can result in wrist drop. Diagnosis is primarily made through physical examination and imaging studies, such as X-rays, which reveal the fracture's location and type. Treatment options vary based on the fracture's severity and may include conservative management with immobilization or surgical intervention, such as intramedullary nailing or plate fixation. Rehabilitation is crucial for restoring function and strength in the affected arm. Understanding the nuances of this condition is essential for accurate coding and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between closed and open fractures
  • Identifying associated injuries (e.g., nerve damage)
  • Variability in treatment approaches (surgical vs. conservative)
  • Documentation of fracture type and location

Audit Risk Factors

  • Inadequate documentation of fracture type
  • Failure to document associated injuries
  • Incorrect coding of fracture location
  • Lack of follow-up documentation for treatment outcomes

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Fractures resulting from sports injuries, falls, or vehicular accidents.

Billing Considerations

Ensure documentation specifies the fracture type, treatment plan, and any complications.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation progress.

Common Clinical Scenarios

Patients undergoing rehabilitation post-fracture repair.

Billing Considerations

Documenting the impact of the fracture on daily activities and recovery milestones.

Coding Guidelines

Inclusion Criteria

Use S42.3 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture's specifics, including laterality and type

Exclusion Criteria

Do NOT use S42.3 When
  • Exclude codes for conditions that do not pertain to the fracture of the shaft of the humerus

Related ICD-10 Codes

Related CPT Codes

24500CPT Code

Open treatment of humeral shaft fracture

Clinical Scenario

Used when surgical intervention is performed for a humeral shaft fracture.

Documentation Requirements

Operative report detailing the procedure and any complications.

Specialty Considerations

Orthopedic surgeons must document the specifics of the fracture and the surgical 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, improving the accuracy of data collection and reimbursement processes. S42.3 provides a clear distinction for humeral shaft fractures, facilitating better patient management and outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of data collection and reimbursement processes. S42.3 provides a clear distinction for humeral shaft fractures, facilitating better patient management and outcomes.

Reimbursement & Billing Impact

reimbursement processes. S42.3 provides a clear distinction for humeral shaft fractures, facilitating better patient management and outcomes.

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 S42.3 and S42.2?

S42.3 refers specifically to fractures of the shaft of the humerus, while S42.2 pertains to fractures of the surgical neck of the humerus. Accurate coding depends on the precise location of the fracture.