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ICD-10 Guide
ICD-10 CodesS42.301

S42.301

Billable

Unspecified fracture of shaft of humerus, right arm

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

Code Description

ICD-10 S42.301 is a billable code used to indicate a diagnosis of unspecified fracture of shaft of humerus, right arm.

Key Diagnostic Point:

An unspecified fracture of the shaft of the humerus in the right arm typically occurs due to trauma, such as falls, sports injuries, or accidents. This type of fracture can lead to significant pain, swelling, and limited mobility in the shoulder and arm. The humerus is the long bone in the upper arm, and fractures can vary in severity from simple, stable fractures to complex, displaced fractures requiring surgical intervention. Diagnosis is usually confirmed through physical examination and imaging studies, such as X-rays or CT scans. Treatment options may include conservative management with immobilization or surgical repair, depending on the fracture's characteristics and the patient's overall health. Rehabilitation is often necessary to restore function and strength to the arm following healing. Understanding the nuances of this fracture is crucial for accurate coding and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and locations
  • Need for precise documentation of injury mechanism
  • Differentiation from other shoulder injuries
  • Potential for surgical intervention

Audit Risk Factors

  • Inadequate documentation of fracture specifics
  • Failure to specify laterality or type of fracture
  • Misclassification of fracture severity
  • Inconsistent treatment documentation

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 vehicular accidents.

Billing Considerations

Ensure documentation reflects the mechanism of injury and any surgical interventions performed.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional status and rehabilitation progress.

Common Clinical Scenarios

Patients undergoing rehabilitation post-fracture repair.

Billing Considerations

Documenting the impact of the fracture on daily activities and rehabilitation goals.

Coding Guidelines

Inclusion Criteria

Use S42.301 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the fracture's specifics, including laterality and type

Exclusion Criteria

Do NOT use S42.301 When
  • Exclude codes for more specific fractures if applicable

Related ICD-10 Codes

Related CPT Codes

23630CPT Code

Open treatment of humeral shaft fracture

Clinical Scenario

Used when surgical intervention is required for fracture repair.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the specifics of the fracture and the surgical approach.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specificity in coding fractures, improving the accuracy of patient records and treatment plans. S42.301 reflects the need for precise documentation to avoid ambiguity in treatment and billing.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specificity in coding fractures, improving the accuracy of patient records and treatment plans. S42.301 reflects the need for precise documentation to avoid ambiguity in treatment 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 S42.301 and S42.302?

S42.301 refers to an unspecified fracture of the shaft of the humerus in the right arm, while S42.302 specifies the same type of fracture in the left arm. Accurate coding requires attention to laterality.