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ICD-10 Guide
ICD-10 CodesS42.211

S42.211

Billable

Unspecified displaced fracture of surgical neck of right humerus

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

Code Description

ICD-10 S42.211 is a billable code used to indicate a diagnosis of unspecified displaced fracture of surgical neck of right humerus.

Key Diagnostic Point:

The unspecified displaced fracture of the surgical neck of the right humerus is a common injury, particularly among older adults and those involved in sports or physical activities. This type of fracture typically occurs due to falls or direct trauma to the shoulder area. The surgical neck is the region just below the head of the humerus, and fractures here can lead to significant complications, including loss of range of motion, pain, and potential damage to surrounding nerves and blood vessels. Diagnosis is usually confirmed through physical examination and imaging studies such as X-rays or MRI. Treatment often involves immobilization, pain management, and in some cases, surgical intervention to realign the bone fragments. Rehabilitation is crucial for restoring function and strength to the shoulder joint. The complexity of managing this fracture can vary based on the patient's age, overall health, and the presence of comorbid conditions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and locations
  • Need for precise documentation of displacement
  • Potential for associated injuries (e.g., rotator cuff tears)
  • Variability in treatment approaches (surgical vs. non-surgical)

Audit Risk Factors

  • Inadequate documentation of fracture specifics
  • Failure to note associated injuries
  • Misclassification of fracture type
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Fracture repair surgeries, post-operative evaluations, and management of complications.

Billing Considerations

Ensure clear documentation of fracture type, displacement, and any surgical interventions performed.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional status and rehabilitation progress.

Common Clinical Scenarios

Rehabilitation post-fracture, management of pain, and restoration of mobility.

Billing Considerations

Document the patient's functional limitations and progress to support the need for therapy.

Coding Guidelines

Inclusion Criteria

Use S42.211 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture's specifics, including laterality and displacement
  • displaced fractures or other specific humeral injuries unless applicable

Exclusion Criteria

Do NOT use S42.211 When
  • Exclude codes for non

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopic rotator cuff repair

Clinical Scenario

Used when a rotator cuff injury is identified alongside the fracture.

Documentation Requirements

Operative reports detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should document the relationship between the fracture and any concurrent injuries.

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 patient records and facilitating better treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of patient records and facilitating better treatment planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of patient records and facilitating better 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 S42.211 and S42.210?

S42.211 refers to a displaced fracture, while S42.210 refers to a non-displaced fracture of the surgical neck of the right humerus.