ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesS42.294

S42.294

Billable

Other nondisplaced fracture of upper end of right humerus

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

Code Description

ICD-10 S42.294 is a billable code used to indicate a diagnosis of other nondisplaced fracture of upper end of right humerus.

Key Diagnostic Point:

The S42.294 code refers to a nondisplaced fracture of the upper end of the right humerus, which is the bone of the upper arm. This type of fracture typically occurs due to low-energy trauma, such as a fall or direct impact, and is characterized by the absence of displacement, meaning the bone fragments remain in their normal anatomical position. Clinically, patients may present with pain, swelling, and limited range of motion in the shoulder. Diagnosis is often confirmed through imaging studies, such as X-rays, which can reveal the fracture line without displacement. Treatment usually involves conservative management, including immobilization with a sling, pain management, and physical therapy to restore function. In some cases, surgical intervention may be necessary if there are associated injuries or if conservative treatment fails to provide adequate relief. Understanding the nuances of this fracture type is essential for accurate coding and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Understanding the specific location of the fracture within the humerus
  • Identifying associated injuries or complications
  • Documentation of the mechanism of injury

Audit Risk Factors

  • Inadequate documentation of the fracture type
  • Failure to specify laterality (right vs. left)
  • Misclassification of fracture displacement
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and follow-up notes are essential for accurate coding.

Common Clinical Scenarios

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

Billing Considerations

Ensure that all associated injuries are documented to support the coding of multiple conditions.

Physical Therapy

Documentation Requirements

Progress notes detailing the patient's rehabilitation progress and response to treatment.

Common Clinical Scenarios

Patients undergoing rehabilitation post-fracture for range of motion and strength.

Billing Considerations

Documenting the initial assessment and ongoing treatment plans is crucial for billing.

Coding Guidelines

Inclusion Criteria

Use S42.294 When
  • According to ICD
  • 10 guidelines, S42
  • 294 should be used when the fracture is confirmed as nondisplaced and located at the upper end of the right humerus
  • It is important to document the mechanism of injury and any associated conditions to ensure accurate coding

Exclusion Criteria

Do NOT use S42.294 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, 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 more specific coding of 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 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 cracks but maintains its proper alignment.