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Home/Diagnosis/ICD-10 Coding for Proximal Humerus Fracture

ICD-10 Coding for Proximal Humerus Fracture

S42.231A
S42.201K

Complete ICD-10-CM coding and documentation guide for icd-10 coding for proximal humerus fracture includes clinical validation requirements, medical necessity guidelines, and coding policies.

Also Known as:
Upper Arm Fracture
Shoulder Fracture
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Key Information: ICD-10 Coding for Proximal Humerus Fracture

Essential facts and insights about ICD-10 Coding for Proximal Humerus Fracture

Use ICD-10 code S42.231A for displaced fracture of greater tuberosity of left humerus, initial encounter, ensuring proper documentation in clinical notes.

Primary ICD-10-CM Codes

Displaced fracture of greater tuberosity of left humerus, initial encounter

Billable Code
S42.231A
Billable

Diagnostic Criteria

clinical:
  • • Presence of a displaced fracture confirmed by imaging
documentation:
  • • Detailed description of fracture pattern and laterality

Applicable To

  • • 3-part displaced fracture

Important Notes

  • • Ensure documentation includes Neer classification and displacement measurements.

Nonunion of fracture of left humerus

Billable Code
S42.201K
Billable

Diagnostic Criteria

clinical:
  • • Imaging showing nonunion
documentation:
  • • Surgical history indicating previous ORIF

Applicable To

  • • Nonunion after ORIF

Important Notes

  • • Ensure follow-up care is documented with appropriate aftercare codes.
Ancillary Codes

Additional codes that may be used with this diagnosis

M97.3-

Periprosthetic fracture around internal prosthetic joint

Use alongside primary fracture code when fracture involves a prosthetic joint.

Frequently Asked Questions

What is the ICD-10 code for a displaced proximal humerus fracture?

The ICD-10 code for a displaced proximal humerus fracture is S42.231A for the left humerus, initial encounter.

How do you document a proximal humerus fracture?

Document a proximal humerus fracture by specifying laterality, displacement, fracture type, and using the Neer classification.

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