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ICD-10 Guide
ICD-10 CodesS42.251

S42.251

Billable

Displaced fracture of greater tuberosity of right humerus

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

Code Description

ICD-10 S42.251 is a billable code used to indicate a diagnosis of displaced fracture of greater tuberosity of right humerus.

Key Diagnostic Point:

A displaced fracture of the greater tuberosity of the right humerus typically occurs due to trauma, such as a fall or direct impact to the shoulder. The greater tuberosity is a prominent bony projection on the humerus where the rotator cuff muscles attach. This type of fracture can lead to significant pain, loss of shoulder function, and potential complications such as rotator cuff tears or shoulder dislocation. Patients may present with limited range of motion, swelling, and tenderness over the shoulder. Diagnosis is usually confirmed through imaging studies, such as X-rays or MRI, which can reveal the extent of the fracture and any associated injuries. Treatment often involves immobilization, physical therapy, and in some cases, surgical intervention to realign the bone fragments and repair any damaged soft tissue. The prognosis is generally favorable with appropriate management, although recovery may take several weeks to months depending on the severity of the fracture and the patient's overall health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of anatomical terminology related to the shoulder.
  • Differentiation from other types of humeral fractures.
  • Need for precise documentation of displacement and associated injuries.
  • Potential for co-morbid conditions affecting treatment and coding.

Audit Risk Factors

  • Inadequate documentation of the fracture type and displacement.
  • Failure to document associated injuries or complications.
  • Incorrect coding of laterality (right vs. left).
  • Misinterpretation of imaging results leading to coding errors.

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging reports, and post-operative care documentation.

Common Clinical Scenarios

Surgical repair of displaced fractures, management of rotator cuff injuries, and post-operative rehabilitation.

Billing Considerations

Ensure accurate coding of any surgical procedures performed in conjunction with fracture repair.

Physical Therapy

Documentation Requirements

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

Common Clinical Scenarios

Rehabilitation following surgical repair or conservative management of shoulder fractures.

Billing Considerations

Documentation should reflect the patient's response to therapy and any modifications to the treatment plan.

Coding Guidelines

Inclusion Criteria

Use S42.251 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture's characteristics, including laterality and displacement
  • Include any associated conditions that may affect treatment

Exclusion Criteria

Do NOT use S42.251 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 S42.251 when a rotator cuff repair is necessary due to associated injury.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should ensure accurate coding of both the fracture and any concurrent procedures.

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 laterality and displacement, which enhances the accuracy of patient records and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including laterality and displacement, which enhances the accuracy of patient records and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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 non-displaced fracture?

A displaced fracture means that the bone fragments are not aligned properly, while a non-displaced fracture means the bone remains in its normal position despite the fracture.