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ICD-10 Guide
ICD-10 CodesS42.325

S42.325

Billable

Nondisplaced transverse fracture of shaft of humerus, left arm

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

Code Description

ICD-10 S42.325 is a billable code used to indicate a diagnosis of nondisplaced transverse fracture of shaft of humerus, left arm.

Key Diagnostic Point:

A nondisplaced transverse fracture of the shaft of the humerus occurs when the bone is broken across its width but remains in alignment. This type of fracture is typically caused by direct trauma or a fall onto an outstretched arm. Patients may present with pain, swelling, and limited range of motion in the shoulder and arm. Diagnosis is confirmed through imaging studies, such as X-rays, which reveal the fracture line without displacement. Treatment often involves conservative management, including immobilization with a sling or brace, followed by physical therapy to restore function. Surgical intervention may be required in cases where the fracture is unstable or if there are associated injuries to the surrounding soft tissues, such as the rotator cuff. Understanding the implications of this fracture is crucial for effective management and rehabilitation, as it can impact the patient's overall shoulder function and quality of life.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Understanding the anatomical location of the humerus
  • Identifying associated injuries, such as rotator cuff tears
  • Documenting the mechanism of injury accurately

Audit Risk Factors

  • Inadequate documentation of the fracture type
  • Failure to document associated injuries
  • Incorrect coding of the fracture location
  • Lack of clarity in the mechanism of injury

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 accidents requiring surgical intervention.

Billing Considerations

Ensure that all associated injuries, such as rotator cuff tears, are documented to support the coding of additional procedures.

Physical Therapy

Documentation Requirements

Progress notes detailing the patient's rehabilitation progress and response to treatment.

Common Clinical Scenarios

Patients undergoing rehabilitation post-fracture to regain strength and range of motion.

Billing Considerations

Document specific functional limitations and goals to support the need for therapy services.

Coding Guidelines

Inclusion Criteria

Use S42.325 When
  • Follow the official ICD
  • CM coding guidelines for fractures, ensuring accurate documentation of the fracture type, location, and any associated injuries
  • Include details about the treatment plan and any surgical interventions

Exclusion Criteria

Do NOT use S42.325 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopic rotator cuff repair

Clinical Scenario

Used if a rotator cuff injury is identified during treatment of the humeral fracture.

Documentation Requirements

Operative reports detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the necessity of the procedure in relation to the fracture.

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. S42.325 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 data collection and reimbursement processes. S42.325 provides a clear distinction between nondisplaced and displaced fractures, which is crucial for treatment planning.

Reimbursement & Billing Impact

reimbursement processes. S42.325 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 displaced and nondisplaced fracture?

A displaced fracture involves a break in the bone where the ends are not aligned, while a nondisplaced fracture means the bone remains in its normal position despite the break.