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ICD-10 Guide
ICD-10 CodesS52.109

S52.109

Billable

Unspecified fracture of upper end of unspecified radius

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

Code Description

ICD-10 S52.109 is a billable code used to indicate a diagnosis of unspecified fracture of upper end of unspecified radius.

Key Diagnostic Point:

An unspecified fracture of the upper end of the radius typically occurs near the elbow joint and can result from various mechanisms of injury, including falls, direct trauma, or sports-related incidents. This type of fracture may present with pain, swelling, and limited range of motion in the elbow. The upper end of the radius is crucial for forearm rotation and elbow stability, making accurate diagnosis and treatment essential. Complications such as compartment syndrome may arise, particularly in cases of severe swelling or hematoma formation, necessitating prompt surgical intervention. Treatment often involves orthopedic fixation procedures, which may include casting or surgical options like open reduction and internal fixation (ORIF) depending on the fracture's complexity and displacement. Accurate coding requires careful documentation of the mechanism of injury, associated symptoms, and any complications that may arise during treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Lack of specificity in the fracture description
  • Potential for multiple associated injuries in the elbow region
  • Variability in treatment approaches based on fracture type
  • Need for detailed documentation to support the diagnosis

Audit Risk Factors

  • Insufficient documentation of the mechanism of injury
  • Failure to document associated conditions like compartment syndrome
  • Inconsistent coding of fracture types in the same patient encounter
  • Lack of follow-up documentation regarding treatment outcomes

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on the mechanism of injury, physical examination findings, and treatment plan.

Common Clinical Scenarios

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

Billing Considerations

Ensure clarity in documentation regarding the fracture's location and any associated injuries.

Emergency Medicine

Documentation Requirements

Comprehensive assessment of the injury, including imaging results and initial treatment provided.

Common Clinical Scenarios

Patients presenting with acute elbow pain and swelling after trauma.

Billing Considerations

Document all relevant findings to support the diagnosis and any immediate interventions performed.

Coding Guidelines

Inclusion Criteria

Use S52.109 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the fracture is unspecified
  • Document any additional details that may help clarify the injury's nature and treatment

Exclusion Criteria

Do NOT use S52.109 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

24500CPT Code

Closed treatment of humeral shaft fracture

Clinical Scenario

Used when treating associated humeral fractures in conjunction with radius fractures.

Documentation Requirements

Document the type of fracture and treatment provided.

Specialty Considerations

Orthopedic specialists should ensure accurate coding of all related procedures.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more detailed coding, but the use of unspecified codes like S52.109 may lead to increased scrutiny during audits. Coders must ensure that documentation supports the use of this code to avoid potential denials.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more detailed coding, but the use of unspecified codes like S52.109 may lead to increased scrutiny during audits. Coders must ensure that documentation supports the use of this code to avoid potential denials.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more detailed coding, but the use of unspecified codes like S52.109 may lead to increased scrutiny during audits. Coders must ensure that documentation supports the use of this code to avoid potential denials.

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 should I document to support the use of S52.109?

Document the mechanism of injury, physical examination findings, imaging results, and treatment plan to provide a comprehensive view of the patient's condition.