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ICD-10 Guide
ICD-10 CodesS42.323

S42.323

Billable

Displaced transverse fracture of shaft of humerus, unspecified arm

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

Code Description

ICD-10 S42.323 is a billable code used to indicate a diagnosis of displaced transverse fracture of shaft of humerus, unspecified arm.

Key Diagnostic Point:

A displaced transverse fracture of the shaft of the humerus is characterized by a break in the bone that occurs across the shaft, resulting in the bone fragments being misaligned. This type of fracture is often caused by high-energy trauma, such as falls or motor vehicle accidents, and can lead to significant pain, swelling, and loss of function in the affected arm. Patients may present with an inability to move the arm, visible deformity, and tenderness over the fracture site. Diagnosis is typically confirmed through imaging studies, such as X-rays, which reveal the fracture pattern and displacement. Treatment often involves orthopedic intervention, which may include closed reduction and immobilization or surgical repair, depending on the severity and displacement of the fracture. Rehabilitation is crucial for restoring function and strength post-injury. Complications can include nonunion, malunion, or nerve injury, particularly to the radial nerve, which runs in proximity to the humerus.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and locations
  • Need for precise documentation of displacement
  • Differentiation from similar fracture codes
  • Potential for associated injuries (e.g., nerve damage)

Audit Risk Factors

  • Inadequate documentation of fracture type and displacement
  • Failure to document associated injuries
  • Incorrect coding of the arm involved
  • Lack of clarity in treatment plans

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 vehicular accidents requiring surgical intervention.

Billing Considerations

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

Physical Therapy

Documentation Requirements

Progress notes detailing rehabilitation goals, treatment modalities, and patient response.

Common Clinical Scenarios

Post-operative rehabilitation following humeral fracture repair.

Billing Considerations

Document functional limitations and progress towards recovery to support coding for therapy services.

Coding Guidelines

Inclusion Criteria

Use S42.323 When
  • According to ICD
  • 10 coding guidelines, S42
  • 323 should be used when the fracture is confirmed as displaced and transverse
  • Coders must ensure that the documentation supports the diagnosis and treatment provided
  • displaced fractures or fractures of the proximal or distal humerus

Exclusion Criteria

Do NOT use S42.323 When
  • Exclusion criteria include non

Related ICD-10 Codes

Related CPT Codes

24500CPT Code

Closed treatment of humeral shaft fracture

Clinical Scenario

Used when a closed reduction is performed for a displaced transverse fracture.

Documentation Requirements

Operative report detailing the procedure and any imaging studies.

Specialty Considerations

Orthopedic surgeons must document the fracture type and treatment 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, including details about displacement and fracture type, which enhances the accuracy of patient records and billing.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including details about displacement and fracture type, which enhances the accuracy of patient records and billing.

Reimbursement & Billing Impact

billing.

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 displaced and non-displaced fractures?

Displaced fractures involve a misalignment of the bone fragments, while non-displaced fractures maintain alignment despite the break.