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ICD-10 Guide
ICD-10 CodesS42.255

S42.255

Billable

Nondisplaced fracture of greater tuberosity of left humerus

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

Code Description

ICD-10 S42.255 is a billable code used to indicate a diagnosis of nondisplaced fracture of greater tuberosity of left humerus.

Key Diagnostic Point:

A nondisplaced fracture of the greater tuberosity of the left humerus occurs when there is a break in the bone at the site of the greater tuberosity, which is a prominent bony projection on the humerus where the rotator cuff muscles attach. This type of fracture is characterized by the absence of displacement, meaning the bone fragments remain in their normal anatomical position. Such fractures are often the result of trauma, such as a fall or direct impact, and can lead to pain, swelling, and limited range of motion in the shoulder. Patients may experience difficulty with overhead activities and may require physical therapy for rehabilitation. Diagnosis typically involves imaging studies, such as X-rays or MRI, to confirm the fracture and assess any associated soft tissue injuries, particularly to the rotator cuff. Treatment may vary from conservative management with rest and physical therapy to surgical intervention if there are complications or if the fracture does not heal properly. Understanding the implications of this fracture is crucial for effective management and recovery.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Understanding associated soft tissue injuries
  • Variability in treatment approaches
  • Need for precise documentation of fracture location

Audit Risk Factors

  • Inadequate documentation of fracture type and location
  • Failure to document associated injuries
  • Misclassification of fracture displacement
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

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

Billing Considerations

Ensure clear documentation of fracture characteristics and any surgical procedures performed.

Physical Therapy

Documentation Requirements

Progress notes detailing patient rehabilitation, range of motion assessments, and treatment plans.

Common Clinical Scenarios

Patients recovering from nondisplaced fractures requiring rehabilitation to restore function.

Billing Considerations

Document specific exercises and patient responses to therapy.

Coding Guidelines

Inclusion Criteria

Use S42.255 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture type, location, and any associated injuries
  • Include details from imaging studies and clinical assessments

Exclusion Criteria

Do NOT use S42.255 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopic rotator cuff repair

Clinical Scenario

Used when surgical intervention is required for associated rotator cuff injuries.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the necessity of surgery based on the fracture and soft tissue assessment.

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 patient records and facilitating better treatment planning. S42.255 provides a clear distinction between nondisplaced and displaced fractures, which is crucial for appropriate management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of patient records and facilitating better treatment planning. S42.255 provides a clear distinction between nondisplaced and displaced fractures, which is crucial for appropriate management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of patient records and facilitating better treatment planning. S42.255 provides a clear distinction between nondisplaced and displaced fractures, which is crucial for appropriate management.

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 remains in its normal position despite the break.