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ICD-10 Guide
ICD-10 CodesS52.1

S52.1

Billable

Fracture of upper end of radius

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

Code Description

ICD-10 S52.1 is a billable code used to indicate a diagnosis of fracture of upper end of radius.

Key Diagnostic Point:

The fracture of the upper end of the radius typically occurs at the radial head, which is the proximal part of the radius that articulates with the humerus at the elbow joint. This type of fracture is often associated with trauma, such as falls or direct blows to the elbow. Patients may present with pain, swelling, and limited range of motion in the elbow. The injury can also lead to complications such as compartment syndrome, which is a serious condition that occurs when pressure within the muscles builds to dangerous levels, potentially leading to muscle and nerve damage. Diagnosis is usually confirmed through physical examination and imaging studies, such as X-rays or MRI. Treatment options vary based on the severity of the fracture and may include conservative management with immobilization or surgical intervention, such as orthopedic fixation procedures to stabilize the fracture. Proper coding requires careful documentation of the mechanism of injury, associated complications, and treatment provided.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types (e.g., non-displaced vs. displaced)
  • Potential for associated injuries (e.g., ligamentous injuries)
  • Need for detailed documentation of treatment approach
  • Variations in surgical techniques and fixation methods

Audit Risk Factors

  • Inadequate documentation of fracture type and treatment
  • Failure to document associated injuries or complications
  • Incorrect coding of the fracture location
  • Lack of clarity in operative reports for surgical procedures

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Fractures resulting from falls, sports injuries, or motor vehicle accidents.

Billing Considerations

Documentation must specify the type of fracture, treatment provided, and any complications encountered.

Emergency Medicine

Documentation Requirements

Initial assessment notes, imaging results, and treatment plans must be documented thoroughly.

Common Clinical Scenarios

Patients presenting with acute elbow pain and swelling after trauma.

Billing Considerations

Accurate coding requires clear documentation of the mechanism of injury and any immediate interventions performed.

Coding Guidelines

Inclusion Criteria

Use S52.1 When
  • According to ICD
  • 10 coding guidelines, S52
  • 1 should be used when the fracture is confirmed through imaging
  • It is important to document the specific type of fracture and any associated complications

Exclusion Criteria

Do NOT use S52.1 When
  • Exclusion criteria include fractures not involving the upper end of the radius

Related ICD-10 Codes

Related CPT Codes

24500CPT Code

Open treatment of radial head fracture

Clinical Scenario

Used when surgical intervention is required for a displaced fracture of the upper end of the radius.

Documentation Requirements

Operative report detailing the procedure, indication for surgery, and post-operative care.

Specialty Considerations

Orthopedic surgeons must ensure that the procedure is well-documented to support the coding.

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 the upper end of the radius. This specificity aids in better tracking of treatment outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including the upper end of the radius. This specificity aids in better tracking of treatment outcomes and resource allocation.

Reimbursement & Billing Impact

reimbursement and compliance.

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 S52.1 and S52.0?

S52.1 refers specifically to fractures of the upper end of the radius, while S52.0 pertains to fractures of the head of the radius. Accurate coding depends on the specific location of the fracture as determined by imaging.