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ICD-10 Guide
ICD-10 CodesS42.321

S42.321

Billable

Displaced transverse fracture of shaft of humerus, right arm

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

Code Description

ICD-10 S42.321 is a billable code used to indicate a diagnosis of displaced transverse fracture of shaft of humerus, right arm.

Key Diagnostic Point:

A displaced transverse fracture of the shaft of the humerus occurs when there is a break in the bone that runs horizontally across the shaft of the humerus, which is the long bone of the upper arm. This type of fracture is characterized by the bone fragments being misaligned or displaced from their normal anatomical position. Such fractures are often the result of high-energy trauma, such as falls or motor vehicle accidents, but can also occur from lower-energy mechanisms in individuals with weakened bone density, such as the elderly. Symptoms typically include severe pain, swelling, and an inability to move the arm. Diagnosis is confirmed through imaging studies, primarily X-rays, which reveal the fracture pattern and displacement. Treatment usually involves immobilization with a sling or brace, and in some cases, surgical intervention may be necessary to realign the bone fragments and stabilize the fracture using plates, screws, or intramedullary nails. Rehabilitation is crucial for restoring function and strength to the arm post-injury.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for precise documentation of fracture type and location
  • Differentiation between displaced and non-displaced fractures
  • Potential for associated injuries (e.g., rotator cuff tears)
  • Variability in treatment approaches (surgical vs. non-surgical)

Audit Risk Factors

  • Inadequate documentation of fracture type and treatment
  • Failure to document associated injuries or complications
  • Incorrect coding of laterality (right vs. left)
  • Lack of follow-up notes on healing progress

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and follow-up assessments are essential.

Common Clinical Scenarios

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

Billing Considerations

Ensure accurate documentation of surgical techniques and materials used for fixation.

Physical Therapy

Documentation Requirements

Progress notes detailing rehabilitation exercises and patient response to treatment.

Common Clinical Scenarios

Post-operative rehabilitation following surgical repair of humeral fractures.

Billing Considerations

Documenting functional limitations and goals for recovery is critical.

Coding Guidelines

Inclusion Criteria

Use S42.321 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture's location, type, and any associated injuries
  • Include laterality and specify if the fracture is open or closed

Exclusion Criteria

Do NOT use S42.321 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

24500CPT Code

Open treatment of humeral shaft fracture

Clinical Scenario

Used when surgical intervention is performed to repair the fracture.

Documentation Requirements

Operative report detailing the procedure, materials used, and post-operative care.

Specialty Considerations

Orthopedic surgeons must document the surgical approach and fixation method.

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. S42.321 provides detailed information about the fracture type and location, which is essential for treatment planning and outcome tracking.

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. S42.321 provides detailed information about the fracture type and location, which is essential for treatment planning and outcome tracking.

Reimbursement & Billing Impact

reimbursement processes. S42.321 provides detailed information about the fracture type and location, which is essential for treatment planning and outcome tracking.

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 non-displaced fracture?

A displaced fracture means the bone fragments are misaligned, while a non-displaced fracture means the bone remains in its normal position despite the break.