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ICD-10 Guide
ICD-10 CodesS42.266

S42.266

Billable

Nondisplaced fracture of lesser tuberosity of unspecified humerus

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

Code Description

ICD-10 S42.266 is a billable code used to indicate a diagnosis of nondisplaced fracture of lesser tuberosity of unspecified humerus.

Key Diagnostic Point:

A nondisplaced fracture of the lesser tuberosity of the humerus is characterized by a break in the bone that does not result in the bone fragments being misaligned. The lesser tuberosity is a small prominence on the humerus where the subscapularis muscle attaches, playing a crucial role in shoulder stability and function. Such fractures often occur due to trauma, such as falls or direct blows to the shoulder, and can be associated with rotator cuff injuries. Patients may present with shoulder pain, limited range of motion, and tenderness over the lesser tuberosity. Diagnosis typically involves physical examination and imaging studies, such as X-rays or MRI, to assess the extent of the injury and rule out associated conditions. Treatment may include conservative management with rest, ice, and physical therapy, or surgical intervention if there is significant functional impairment or associated injuries. Understanding the implications of this fracture is essential for effective management and rehabilitation, as it can impact shoulder mechanics and overall mobility.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Understanding the anatomical significance of the lesser tuberosity
  • Identifying associated injuries, such as rotator cuff tears
  • Variability in documentation practices among providers

Audit Risk Factors

  • Inadequate documentation of the fracture type
  • Failure to note associated injuries
  • Misinterpretation of imaging results
  • Inconsistent terminology used in clinical notes

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

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

Billing Considerations

Ensure clear documentation of the fracture type and any surgical procedures performed.

Physical Therapy

Documentation Requirements

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

Common Clinical Scenarios

Rehabilitation following a nondisplaced fracture to restore shoulder function.

Billing Considerations

Documenting patient compliance and response to therapy is crucial for billing.

Coding Guidelines

Inclusion Criteria

Use S42.266 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture type and any associated conditions
  • Include details about the mechanism of injury and treatment plan

Exclusion Criteria

Do NOT use S42.266 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, surgical

Clinical Scenario

Used when surgical intervention is required for associated injuries.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgery.

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 data collection and reimbursement processes. This code provides clarity in documenting nondisplaced fractures, which can lead to better patient management and outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of data collection and reimbursement processes. This code provides clarity in documenting nondisplaced fractures, which can lead to better patient management and outcomes.

Reimbursement & Billing Impact

reimbursement processes. This code provides clarity in documenting nondisplaced fractures, which can lead to better patient management and outcomes.

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 the lesser tuberosity fracture?

The lesser tuberosity is critical for shoulder stability and function, and fractures in this area can affect the rotator cuff, leading to pain and limited mobility.