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v1.0.0
ICD-10 Guide
ICD-10 CodesS42.326

S42.326

Billable

Nondisplaced transverse fracture of shaft of humerus, unspecified arm

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

Code Description

ICD-10 S42.326 is a billable code used to indicate a diagnosis of nondisplaced transverse fracture of shaft of humerus, unspecified arm.

Key Diagnostic Point:

A nondisplaced transverse fracture of the shaft of the humerus is characterized by a break in the bone that does not result in the bone fragments being displaced from their normal alignment. This type of fracture typically occurs due to direct trauma or falls, particularly in older adults or individuals engaged in high-impact sports. Clinically, patients may present with localized pain, swelling, and limited range of motion in the affected arm. Diagnosis is confirmed through imaging studies, such as X-rays, which reveal the fracture line without displacement. Treatment often involves conservative management, including immobilization with a sling or brace, pain management, and physical therapy to restore function. Surgical intervention may be necessary if the fracture is associated with other injuries or if conservative treatment fails. Understanding the nuances of this fracture type is crucial for accurate coding and appropriate management in orthopedic settings.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Identifying the specific location of the fracture
  • Understanding associated injuries (e.g., rotator cuff tears)
  • Variability in treatment approaches (surgical vs. conservative)

Audit Risk Factors

  • Inadequate documentation of fracture type and location
  • Failure to document associated injuries or conditions
  • Misclassification of fracture displacement status
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and post-operative care notes are essential for accurate coding.

Common Clinical Scenarios

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

Billing Considerations

Ensure clear documentation of fracture type, location, and any associated injuries to support coding.

Physical Therapy

Documentation Requirements

Progress notes detailing range of motion, strength assessments, and treatment plans.

Common Clinical Scenarios

Rehabilitation following humeral fractures, focusing on restoring function and mobility.

Billing Considerations

Documenting patient progress and response to therapy is crucial for coding and billing.

Coding Guidelines

Inclusion Criteria

Use S42.326 When
  • Follow ICD
  • CM guidelines for coding fractures, including the need for specificity regarding the type and location of the fracture
  • Ensure compliance with documentation standards for imaging and clinical findings

Exclusion Criteria

Do NOT use S42.326 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopic rotator cuff repair

Clinical Scenario

Used when a rotator cuff injury is present alongside a humeral fracture.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the relationship between the fracture and any surgical interventions.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding fractures, improving the accuracy of patient records and facilitating better treatment planning. S42.326 reflects the need for precise documentation of fracture types, which is crucial for appropriate reimbursement and care management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding fractures, improving the accuracy of patient records and facilitating better treatment planning. S42.326 reflects the need for precise documentation of fracture types, which is crucial for appropriate reimbursement and care management.

Reimbursement & Billing Impact

reimbursement and care management.

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 the bone fragments being misaligned, while a nondisplaced fracture means the bone remains in its normal position despite the fracture.