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v1.0.0
ICD-10 Guide
ICD-10 CodesS42.239

S42.239

Billable

3-part fracture of surgical neck of unspecified humerus

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

Code Description

ICD-10 S42.239 is a billable code used to indicate a diagnosis of 3-part fracture of surgical neck of unspecified humerus.

Key Diagnostic Point:

A 3-part fracture of the surgical neck of the humerus typically involves three distinct fragments of bone resulting from trauma, often seen in elderly patients due to falls or in younger individuals due to high-energy impacts. This type of fracture is characterized by the involvement of the surgical neck, which is the area just below the head of the humerus. The surgical neck is a common site for fractures, particularly in cases of shoulder dislocation or trauma. Patients may present with 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 often involves orthopedic intervention, which may include surgical repair, fixation, or in some cases, shoulder arthroplasty, depending on the severity and displacement of the fracture. Rehabilitation is crucial for restoring function and strength to the shoulder joint post-injury.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

Audit Risk Factors

  • Inadequate documentation of fracture details
  • Failure to document associated injuries
  • Incorrect coding of fracture type
  • Lack of clarity in treatment plans

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging reports, and follow-up assessments are essential.

Common Clinical Scenarios

Fractures resulting from falls in elderly patients, sports injuries in younger patients.

Billing Considerations

Ensure clear documentation of fracture classification and any surgical interventions performed.

Physical Therapy

Documentation Requirements

Progress notes detailing patient rehabilitation, range of motion assessments, and functional outcomes.

Common Clinical Scenarios

Post-operative rehabilitation following surgical repair of humeral fractures.

Billing Considerations

Document specific therapy goals and patient progress to support billing.

Coding Guidelines

Inclusion Criteria

Use S42.239 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the fracture type, location, and any associated injuries
  • Include details on treatment plans and follow
  • up care

Exclusion Criteria

Do NOT use S42.239 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopic repair of rotator cuff

Clinical Scenario

Used in conjunction with S42.239 when a rotator cuff injury is present.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should ensure accurate linkage between the fracture and any surgical repairs performed.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, including the ability to capture details about the type and location of the fracture, which aids in better patient management and billing accuracy.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including the ability to capture details about the type and location of the fracture, which aids in better patient management and billing accuracy.

Reimbursement & Billing Impact

billing accuracy.

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 2-part and a 3-part fracture of the surgical neck of the humerus?

A 2-part fracture involves two fragments of bone, while a 3-part fracture involves three distinct fragments, often indicating more severe displacement and a higher likelihood of requiring surgical intervention.