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ICD-10 Guide
ICD-10 CodesS42.30

S42.30

Billable

Unspecified fracture of shaft of humerus

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

Code Description

ICD-10 S42.30 is a billable code used to indicate a diagnosis of unspecified fracture of shaft of humerus.

Key Diagnostic Point:

The unspecified fracture of the shaft of the humerus refers to a break in the long bone of the upper arm, which can occur due to various mechanisms such as falls, direct trauma, or sports injuries. This type of fracture is characterized by pain, swelling, and limited range of motion in the shoulder and arm. Patients may present with visible deformity or inability to use the affected arm. Diagnosis typically involves physical examination and imaging studies, such as X-rays, to confirm the fracture and rule out associated injuries. Treatment may vary based on the fracture's severity and displacement, ranging from conservative management with immobilization to surgical intervention for more complex cases. Surgical options may include internal fixation with plates or rods, particularly in cases where the fracture is unstable or involves significant displacement. Rehabilitation is crucial for restoring function and strength post-injury, especially in athletes or active individuals. Understanding the nuances of this code is essential for accurate billing and documentation, as it encompasses a wide range of clinical presentations and treatment modalities.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and locations within the humerus
  • Potential for associated injuries, such as rotator cuff tears
  • Need for precise documentation of fracture characteristics
  • Differentiation from other shoulder injuries, such as dislocations

Audit Risk Factors

  • Inadequate documentation of fracture specifics
  • Failure to document associated injuries or conditions
  • Inconsistent coding of treatment modalities
  • Lack of clarity on the mechanism of injury

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and pre/post-operative assessments.

Common Clinical Scenarios

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

Billing Considerations

Ensure documentation reflects the complexity of the fracture and any associated injuries.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation progress.

Common Clinical Scenarios

Patients recovering from humeral fractures requiring physical therapy.

Billing Considerations

Document the patient's functional status and rehabilitation goals to support coding.

Coding Guidelines

Inclusion Criteria

Use S42.30 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the fracture type, location, and any associated injuries

Exclusion Criteria

Do NOT use S42.30 When
  • Exclude codes for specific fracture types if applicable

Related ICD-10 Codes

Related CPT Codes

23630CPT 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 findings.

Specialty Considerations

Orthopedic surgeons must document the specifics of the fracture and surgical approach.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specificity in coding fractures, improving the ability to capture the complexity of injuries like humeral shaft fractures. This has implications for treatment planning and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specificity in coding fractures, improving the ability to capture the complexity of injuries like humeral shaft fractures. This has implications for treatment planning and reimbursement.

Reimbursement & Billing Impact

reimbursement.

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 S42.30 and S42.31?

S42.30 is used for unspecified fractures of the shaft of the humerus, while S42.31 is specifically for fractures of the surgical neck of the humerus. Accurate documentation is essential to determine the correct code.