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v1.0.0
ICD-10 Guide
ICD-10 CodesS42.222

S42.222

Billable

2-part displaced fracture of surgical neck of left humerus

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

Code Description

ICD-10 S42.222 is a billable code used to indicate a diagnosis of 2-part displaced fracture of surgical neck of left humerus.

Key Diagnostic Point:

A 2-part displaced fracture of the surgical neck of the left humerus typically occurs due to trauma, such as a fall or direct impact to the shoulder. This type of fracture is characterized by a break in the bone that results in two distinct fragments, which are not aligned properly (displaced). The surgical neck is a common site for fractures in the humerus, particularly in older adults or individuals with osteoporosis. Symptoms often include severe pain, swelling, and limited range of motion in the shoulder. Diagnosis is usually confirmed through imaging studies such as X-rays or CT scans. Treatment may involve conservative management with immobilization or surgical intervention, depending on the degree of displacement and the patient's overall health. Surgical options may include open reduction and internal fixation (ORIF) or shoulder arthroplasty in more severe cases. Rehabilitation is crucial for restoring function and strength post-injury.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires precise documentation of fracture type and location.
  • Differentiation between displaced and non-displaced fractures.
  • Potential for multiple treatment options affecting coding.
  • Need for accurate imaging reports to support coding.

Audit Risk Factors

  • Inadequate documentation of fracture details.
  • Failure to specify laterality (left vs. right).
  • Misclassification of fracture type (displaced vs. non-displaced).
  • Lack of imaging documentation to support the diagnosis.

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Fractures due to falls, sports injuries, or accidents requiring surgical intervention.

Billing Considerations

Ensure clear documentation of fracture type and treatment plan, including any complications.

Physical Therapy

Documentation Requirements

Initial evaluation notes, progress reports, and discharge summaries.

Common Clinical Scenarios

Rehabilitation following surgical repair of humeral fractures.

Billing Considerations

Document functional limitations and progress towards rehabilitation goals.

Coding Guidelines

Inclusion Criteria

Use S42.222 When
  • Follow official ICD
  • CM coding guidelines, ensuring accurate documentation of fracture type, laterality, and any associated injuries
  • Include details from imaging studies and surgical reports when applicable

Exclusion Criteria

Do NOT use S42.222 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23630CPT Code

Open treatment of humeral head fracture

Clinical Scenario

Used when surgical intervention is performed for a displaced 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 specific coding of fractures, improving the accuracy of patient records and billing. S42.222 provides detailed information about the fracture type, which aids in treatment planning and outcomes tracking.

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 billing. S42.222 provides detailed information about the fracture type, which aids in treatment planning and outcomes tracking.

Reimbursement & Billing Impact

billing. S42.222 provides detailed information about the fracture type, which aids in treatment planning and outcomes tracking.

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 S42.222 and S42.221?

S42.222 is used for a 2-part displaced fracture, while S42.221 is for a 2-part non-displaced fracture. Accurate documentation of displacement is crucial for correct coding.