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v1.0.0
ICD-10 Guide
ICD-10 CodesS42.242

S42.242

Billable

4-part fracture of surgical neck of left humerus

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

Code Description

ICD-10 S42.242 is a billable code used to indicate a diagnosis of 4-part fracture of surgical neck of left humerus.

Key Diagnostic Point:

A 4-part fracture of the surgical neck of the left humerus is a complex injury that typically occurs due to high-energy trauma, such as falls or motor vehicle accidents. This type of fracture involves four distinct fragments of the humerus, which can complicate treatment and recovery. The surgical neck is located just below the head of the humerus and is a common site for fractures, particularly in older adults with osteoporosis. Symptoms include severe pain, swelling, and limited range of motion in the shoulder. Diagnosis is confirmed through imaging studies, such as X-rays or CT scans, which reveal the fracture pattern. Treatment often requires surgical intervention, including internal fixation or shoulder arthroplasty, depending on the fracture's severity and the patient's overall health. Rehabilitation is crucial for restoring function and strength to the shoulder joint, and may involve physical therapy to improve mobility and reduce stiffness.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Involvement of multiple fracture fragments complicates coding.
  • Requires precise documentation of fracture type and location.
  • Potential for associated soft tissue injuries increases complexity.
  • Surgical intervention may vary based on fracture pattern, affecting coding.

Audit Risk Factors

  • Inadequate documentation of fracture details.
  • Failure to specify laterality (left vs. right).
  • Misclassification of fracture type.
  • Lack of supporting imaging documentation.

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and pre-operative assessments are essential.

Common Clinical Scenarios

Fractures resulting from falls, sports injuries, or vehicular accidents.

Billing Considerations

Ensure accurate documentation of fracture classification and treatment plan.

Physical Therapy

Documentation Requirements

Progress notes detailing rehabilitation goals, treatment modalities, and patient response.

Common Clinical Scenarios

Post-operative rehabilitation following surgical repair of humeral fractures.

Billing Considerations

Document functional limitations and progress towards recovery.

Coding Guidelines

Inclusion Criteria

Use S42.242 When
  • Follow official ICD
  • CM guidelines for coding fractures, including the need for specificity regarding the type and location of the fracture
  • Ensure compliance with guidelines for laterality and the use of additional codes for associated injuries

Exclusion Criteria

Do NOT use S42.242 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, surgical

Clinical Scenario

Used for surgical repair of the shoulder following a 4-part fracture.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the complexity of the fracture.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding fractures, including the ability to capture laterality and the complexity of the fracture. This has improved the accuracy of coding and billing, but also requires coders to be more diligent in documentation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding fractures, including the ability to capture laterality and the complexity of the fracture. This has improved the accuracy of coding and billing, but also requires coders to be more diligent in documentation.

Reimbursement & Billing Impact

billing, but also requires coders to be more diligent in documentation.

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 significance of a 4-part fracture?

A 4-part fracture indicates a more complex injury that may require surgical intervention and has a higher risk of complications compared to simpler fractures.