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ICD-10 Guide
ICD-10 CodesS42.27

S42.27

Billable

Torus fracture of upper end of humerus

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

Code Description

ICD-10 S42.27 is a billable code used to indicate a diagnosis of torus fracture of upper end of humerus.

Key Diagnostic Point:

A torus fracture, also known as a buckle fracture, is a common type of incomplete fracture typically seen in children due to the pliability of their bones. In the context of the upper end of the humerus, this fracture occurs at the proximal humerus, which is the area closest to the shoulder joint. The mechanism of injury often involves a fall onto an outstretched arm or direct trauma to the shoulder. Clinically, patients may present with localized pain, swelling, and limited range of motion in the shoulder. Diagnosis is typically confirmed through X-ray imaging, which reveals the characteristic buckling of the cortex without complete disruption of the bone. Treatment usually involves immobilization with a sling or splint, and in some cases, physical therapy may be recommended to restore function. Understanding the nuances of this fracture is crucial for accurate coding, as it can impact treatment plans and reimbursement processes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between torus fractures and complete fractures
  • Understanding the age-related prevalence of this fracture type
  • Recognizing associated injuries in the shoulder region
  • Documentation of clinical findings and imaging results

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the type of fracture (torus vs. complete)
  • Lack of follow-up documentation on healing progress
  • Misclassification of the fracture type leading to incorrect coding

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes including mechanism of injury, physical examination findings, and imaging results.

Common Clinical Scenarios

Patients presenting with shoulder pain after a fall, children with arm injuries from sports activities.

Billing Considerations

Ensure accurate documentation of fracture type and any associated injuries to avoid coding errors.

Pediatrics

Documentation Requirements

Growth and development history, details of the injury, and follow-up care plans.

Common Clinical Scenarios

Children with torus fractures due to falls or accidents.

Billing Considerations

Consider the child's age and activity level when documenting and coding.

Coding Guidelines

Inclusion Criteria

Use S42.27 When
  • According to ICD
  • 10 guidelines, S42
  • 27 should be used when a torus fracture of the upper end of the humerus is confirmed through imaging
  • It is important to document the specific location and type of fracture, as well as any associated injuries

Exclusion Criteria

Do NOT use S42.27 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits after initial diagnosis of a torus fracture.

Documentation Requirements

Documentation of the patient's progress, treatment plan, and any new symptoms.

Specialty Considerations

Orthopedic specialists may require more detailed documentation of physical examination findings.

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 torus fractures, which enhances the accuracy of patient records and reimbursement processes. This specificity helps in tracking treatment outcomes and improving patient care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including torus fractures, which enhances the accuracy of patient records and reimbursement processes. This specificity helps in tracking treatment outcomes and improving patient care.

Reimbursement & Billing Impact

reimbursement processes. This specificity helps in tracking treatment outcomes and improving patient care.

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 a torus fracture?

A torus fracture is an incomplete fracture characterized by a bulging of the bone cortex, commonly seen in children due to the flexibility of their bones. It typically occurs in the upper end of the humerus following a fall or trauma.