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ICD-10 Guide
ICD-10 CodesS42.29

S42.29

Billable

Other fracture of upper end of humerus

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

Code Description

ICD-10 S42.29 is a billable code used to indicate a diagnosis of other fracture of upper end of humerus.

Key Diagnostic Point:

The S42.29 code refers to fractures occurring at the upper end of the humerus that do not fall into more specific categories such as surgical neck fractures or greater/lesser tuberosity fractures. These fractures can result from various mechanisms, including falls, direct trauma, or sports injuries. Clinically, patients may present with shoulder pain, swelling, and limited range of motion. Diagnosis typically involves physical examination and imaging studies, such as X-rays or MRI, to assess the fracture's nature and extent. Treatment may vary from conservative management, including immobilization and physical therapy, to surgical interventions like open reduction and internal fixation (ORIF) depending on the fracture's complexity and the patient's functional demands. Understanding the nuances of this code is essential for accurate billing and ensuring appropriate care pathways are followed.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and locations within the upper end of the humerus.
  • Need for precise documentation to differentiate from other humeral fractures.
  • Potential for concurrent shoulder injuries, complicating coding.
  • Variations in treatment approaches based on fracture severity and patient age.

Audit Risk Factors

  • Inadequate documentation of fracture specifics.
  • Failure to document associated injuries or conditions.
  • Incorrect linkage of diagnosis to treatment procedures.
  • Use of unspecified codes when more specific codes are available.

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Fractures resulting from falls in elderly patients, sports-related injuries in younger patients.

Billing Considerations

Ensure documentation reflects the fracture type and any surgical interventions performed.

Physical Therapy

Documentation Requirements

Initial evaluation notes, progress reports, and discharge summaries.

Common Clinical Scenarios

Rehabilitation following surgical repair of humeral fractures.

Billing Considerations

Document functional limitations and progress towards rehabilitation goals.

Coding Guidelines

Inclusion Criteria

Use S42.29 When
  • According to ICD
  • 10 guidelines, S42
  • 29 should be used when the fracture is not specified as a surgical neck or tuberosity fracture
  • Coders must ensure that the documentation supports the diagnosis and that all relevant details are captured

Exclusion Criteria

Do NOT use S42.29 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, surgical

Clinical Scenario

Used in cases where surgical intervention is required for upper humeral fractures.

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. S42.29 provides a means to capture less common fracture types that may have been previously coded as unspecified in ICD-9.

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. S42.29 provides a means to capture less common fracture types that may have been previously coded as unspecified in ICD-9.

Reimbursement & Billing Impact

reimbursement processes. S42.29 provides a means to capture less common fracture types that may have been previously coded as unspecified in ICD-9.

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 S42.29 and S42.21?

S42.29 is used for other fractures of the upper end of the humerus that do not fit into more specific categories like S42.21, which is specifically for surgical neck fractures.