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v1.0.0
ICD-10 Guide
ICD-10 CodesS42.225

S42.225

Billable

2-part nondisplaced fracture of surgical neck of left humerus

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

Code Description

ICD-10 S42.225 is a billable code used to indicate a diagnosis of 2-part nondisplaced fracture of surgical neck of left humerus.

Key Diagnostic Point:

A 2-part nondisplaced fracture of the surgical neck of the left humerus typically occurs due to trauma, such as a fall or direct impact. This type of fracture is characterized by the fracture line dividing the humerus into two distinct fragments without significant displacement. The surgical neck is a common site for fractures, especially in older adults with osteoporosis or in younger individuals involved in high-impact sports. Clinically, patients may present with shoulder pain, swelling, and limited range of motion. Diagnosis is confirmed through imaging studies, such as X-rays or MRI, which reveal the fracture's location and confirm the absence of displacement. Treatment often involves conservative management, including immobilization with a sling and physical therapy to restore function. Surgical intervention may be considered if there are complications or if the fracture does not heal properly. Understanding the nuances of this fracture type is crucial for accurate coding and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation between displaced and nondisplaced fractures
  • Understanding of anatomical terminology related to the humerus
  • Knowledge of associated complications and treatment options
  • Variability in documentation practices among providers

Audit Risk Factors

  • Inadequate documentation of fracture type and location
  • Failure to specify laterality (left vs. right)
  • Misuse of codes for related shoulder injuries
  • Inconsistent terminology between clinical notes and coding

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes if surgery is performed, including fracture type, fixation method, and post-operative care.

Common Clinical Scenarios

Fractures resulting from falls, sports injuries, or accidents requiring surgical intervention.

Billing Considerations

Ensure accurate documentation of fracture characteristics and treatment plans to support coding.

Physical Therapy

Documentation Requirements

Progress notes detailing range of motion, strength assessments, and rehabilitation goals.

Common Clinical Scenarios

Patients recovering from nondisplaced fractures undergoing rehabilitation.

Billing Considerations

Document functional limitations and progress to justify therapy services.

Coding Guidelines

Inclusion Criteria

Use S42.225 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture type, laterality, and any associated injuries
  • Include relevant clinical details to support the diagnosis

Exclusion Criteria

Do NOT use S42.225 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopic shoulder surgery

Clinical Scenario

Used in cases where surgical intervention is necessary for fracture stabilization.

Documentation Requirements

Operative report detailing the procedure performed and indications for surgery.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgical intervention.

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. S42.225 provides a clear distinction between fracture types, which aids in treatment planning and outcome tracking.

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. S42.225 provides a clear distinction between fracture types, which aids in treatment planning and outcome tracking.

Reimbursement & Billing Impact

reimbursement processes. S42.225 provides a clear distinction between fracture types, which aids in treatment planning and outcome 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 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 cracks but maintains its proper alignment.