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ICD-10 Guide
ICD-10 CodesS42.302

S42.302

Billable

Unspecified fracture of shaft of humerus, left arm

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

Code Description

ICD-10 S42.302 is a billable code used to indicate a diagnosis of unspecified fracture of shaft of humerus, left arm.

Key Diagnostic Point:

An unspecified fracture of the shaft of the humerus in the left arm typically occurs due to trauma, such as falls, sports injuries, or accidents. This type of fracture can lead to significant pain, swelling, and limited mobility in the affected arm. Patients may present with a visible deformity or may be unable to move the arm due to pain. Diagnosis is primarily made through physical examination and imaging studies, such as X-rays, which help confirm the fracture and rule out associated injuries. Treatment often involves immobilization with a sling or brace, and in some cases, surgical intervention may be necessary to realign the bone fragments and stabilize the fracture. Complications can include nonunion or malunion of the fracture, which may require further surgical repair. Rehabilitation is crucial for restoring function and strength to the arm post-injury.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and locations within the humerus
  • Need for precise documentation of fracture characteristics
  • Potential for associated injuries (e.g., rotator cuff tears)
  • Differentiation from other shoulder injuries

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify laterality or fracture type
  • Misclassification of fracture severity
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

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

Billing Considerations

Ensure documentation reflects the type of fracture and any surgical interventions performed.

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 patient's functional status and response to therapy is critical.

Coding Guidelines

Inclusion Criteria

Use S42.302 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code accurately reflects the diagnosis based on clinical documentation
  • Include any relevant details about the fracture's characteristics and treatment plan

Exclusion Criteria

Do NOT use S42.302 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23630CPT Code

Closed treatment of humeral shaft fracture

Clinical Scenario

Used when a closed reduction is performed for a humeral shaft fracture.

Documentation Requirements

Operative report detailing the procedure and any imaging studies.

Specialty Considerations

Orthopedic surgeons should ensure accurate coding based on the surgical approach.

24500CPT Code

Open treatment of humeral shaft fracture

Clinical Scenario

Used when an open reduction and internal fixation is performed.

Documentation Requirements

Detailed operative report and post-operative care notes.

Specialty Considerations

Documentation must reflect the complexity of the procedure.

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 granularity of data collection and reimbursement processes. S42.302 provides a clear designation for unspecified fractures, which can help in tracking treatment outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the granularity of data collection and reimbursement processes. S42.302 provides a clear designation for unspecified fractures, which can help in tracking treatment outcomes and resource allocation.

Reimbursement & Billing Impact

reimbursement processes. S42.302 provides a clear designation for unspecified fractures, which can help in tracking treatment outcomes and resource allocation.

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 S42.302 and S42.301?

S42.302 refers to an unspecified fracture of the shaft of the humerus in the left arm, while S42.301 refers to the same type of fracture in the right arm. Accurate coding requires specifying the laterality.