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v1.0.0
ICD-10 Guide
ICD-10 CodesS42.224

S42.224

Billable

2-part nondisplaced fracture of surgical neck of right humerus

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

Code Description

ICD-10 S42.224 is a billable code used to indicate a diagnosis of 2-part nondisplaced fracture of surgical neck of right humerus.

Key Diagnostic Point:

A 2-part nondisplaced fracture of the surgical neck of the right humerus typically occurs due to a fall or direct trauma to the shoulder area. This type of fracture is characterized by a break in the bone that does not result in the bone fragments being displaced from their normal anatomical position. The surgical neck is a common site for fractures in the humerus, especially in older adults or individuals with osteoporosis. Symptoms may include localized pain, swelling, and limited range of motion in the shoulder. Diagnosis is usually confirmed through imaging studies such as X-rays or MRI. Treatment often involves conservative management, including immobilization with a sling and physical therapy, although surgical intervention may be necessary in cases where the fracture is associated with significant soft tissue injury or if the patient does not respond to conservative treatment. Understanding the nuances of this fracture type is essential for accurate coding and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Understanding the anatomical terminology related to the humerus
  • Identifying the specific location of the fracture (surgical neck vs. anatomical neck)
  • Documenting associated injuries or complications

Audit Risk Factors

  • Inadequate documentation of fracture type and location
  • Failure to document associated injuries or complications
  • Misclassification of fracture displacement
  • Lack of follow-up documentation regarding treatment outcomes

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

Fracture repair, shoulder arthroscopy, and management of complications related to humeral fractures.

Billing Considerations

Ensure that all relevant imaging and treatment plans are documented to support the coding.

Physical Therapy

Documentation Requirements

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

Common Clinical Scenarios

Post-fracture rehabilitation, range of motion exercises, and strength training.

Billing Considerations

Document specific goals and outcomes related to the fracture recovery process.

Coding Guidelines

Inclusion Criteria

Use S42.224 When
  • According to ICD
  • 10 guidelines, S42
  • 224 should be used when the fracture is confirmed as nondisplaced and located at the surgical neck of the right humerus
  • It is important to document the mechanism of injury and any associated conditions

Exclusion Criteria

Do NOT use S42.224 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopic shoulder surgery

Clinical Scenario

Used in conjunction with S42.224 if surgical intervention is performed.

Documentation Requirements

Operative reports detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgery.

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. S42.224 provides a clear distinction between nondisplaced and displaced fractures, which is essential 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. S42.224 provides a clear distinction between nondisplaced and displaced fractures, which is essential for treatment planning.

Reimbursement & Billing Impact

reimbursement processes. S42.224 provides a clear distinction between nondisplaced and displaced fractures, which is essential 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 the bone fragments being misaligned or separated, while a nondisplaced fracture means the bone remains in its normal position despite the break.