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ICD-10 Guide
ICD-10 CodesS42.252

S42.252

Billable

Displaced fracture of greater tuberosity of left humerus

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

Code Description

ICD-10 S42.252 is a billable code used to indicate a diagnosis of displaced fracture of greater tuberosity of left humerus.

Key Diagnostic Point:

A displaced fracture of the greater tuberosity of the left humerus typically occurs due to trauma, such as a fall or direct impact to the shoulder. The greater tuberosity is a bony prominence on the humerus where rotator cuff muscles attach, making this type of fracture significant in terms of shoulder function. Patients may present with severe shoulder pain, swelling, and limited range of motion. Diagnosis is often confirmed through imaging studies, such as X-rays or MRI, which can reveal the extent of the fracture and any associated soft tissue injuries. Treatment may involve conservative management with immobilization and physical therapy, or surgical intervention if the fracture is significantly displaced or if there is associated rotator cuff injury. Surgical options may include open reduction and internal fixation (ORIF) or arthroscopic repair, depending on the fracture's complexity and the patient's overall health. Rehabilitation is crucial for restoring function and strength to the shoulder joint post-injury.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of anatomical terminology related to the shoulder.
  • Differentiation between displaced and non-displaced fractures.
  • Potential for associated rotator cuff injuries complicating coding.
  • Need for accurate documentation of imaging studies and treatment plans.

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury.
  • Failure to specify the laterality of the fracture.
  • Lack of detailed operative reports for surgical cases.
  • Misclassification of fracture type (displaced vs. non-displaced).

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Fracture repair surgeries, rotator cuff repairs, and shoulder arthroplasties.

Billing Considerations

Ensure clarity in documenting the type of fracture and any associated procedures performed.

Physical Therapy

Documentation Requirements

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

Common Clinical Scenarios

Rehabilitation following surgical repair of shoulder fractures.

Billing Considerations

Documenting the patient's response to therapy and any modifications to the treatment plan.

Coding Guidelines

Inclusion Criteria

Use S42.252 When
  • Follow official ICD
  • CM guidelines for coding fractures, including specificity for laterality and type of fracture
  • Ensure documentation supports the diagnosis and any associated conditions

Exclusion Criteria

Do NOT use S42.252 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopic repair of rotator cuff

Clinical Scenario

Used in cases where the fracture is associated with a rotator cuff tear.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should ensure clear documentation of the fracture and any repairs performed.

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 laterality and displacement status, which enhances the accuracy of patient records and billing.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding fractures, including laterality and displacement status, which enhances the accuracy of patient records and billing.

Reimbursement & Billing Impact

billing.

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 coding the displacement of the fracture?

Coding the displacement is crucial as it affects treatment options and prognosis. Displaced fractures often require surgical intervention, while non-displaced fractures may be managed conservatively.