2025 ICD-10-CM code S42.301A
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Injury - Injuries to the shoulder and upper arm (S40-S49) Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88) Feed
Unspecified fracture of the humerus shaft in the right arm; initial encounter for a closed fracture.
ICD-10 codes do not utilize modifiers.
Medical necessity is established by the presence of a fracture requiring treatment to ensure proper healing and restoration of function. Documentation should support the need for imaging, immobilization, and any surgical procedures performed.
The clinical responsibility for this code involves diagnosis and treatment of the fracture.This may include a thorough history and physical exam, imaging studies (x-rays, CT scan), pain management, immobilization (splint or cast), and potential surgical intervention for reduction and internal fixation.Post-operative care and physical therapy may also be necessary.
- Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88)
- S42.301A is part of the larger block S42.3, which encompasses unspecified fractures of the humeral shaft. This further falls under the broader category of injuries to the shoulder and upper arm (S40-S49) within Chapter 19 of ICD-10-CM.
In simple words: This code means a broken bone in the middle part of the upper right arm bone (humerus), but the break doesn't go through the skin. This is the first time this injury is being documented by a healthcare provider.
This code signifies an unspecified fracture of the humeral shaft in the right arm during the initial encounter, where the fracture is closed (the bone doesn't break through the skin).It encompasses breaks in the central portion of the humerus, with or without displacement of bone fragments, resulting from trauma such as falls, accidents, or sports injuries.The specific fracture type is not specified.Further codes may be necessary to identify the cause of injury (from Chapter 20), any retained foreign body (Z18.-), and subsequent encounters.
Example 1: A patient falls and sustains a closed fracture of the humerus shaft.The initial visit involves x-rays, pain management, and application of a cast., A patient is involved in a motor vehicle accident and sustains a closed humeral shaft fracture. Initial treatment includes pain control, a temporary splint, and subsequent orthopedic consultation., An athlete suffers a closed humeral shaft fracture during a sports game. The initial evaluation involves imaging, pain relief, and referral for fracture management.
Thorough documentation is essential and should include a detailed patient history (mechanism of injury, time of injury), physical examination findings (swelling, deformity, tenderness, neurovascular status), imaging reports (x-rays, CT scan, MRI if performed), details of treatment rendered, and any complications or comorbidities.Progress notes should document healing progress in subsequent encounters.
** This code is for the initial encounter of a closed fracture.Subsequent encounters require different codes within the S42.301 series to reflect the healing progress.
- Revenue Code: Revenue codes will vary based on the healthcare provider and payer, and will not be specific to the ICD-10 code itself.
- RVU: RVUs are not directly associated with ICD-10 codes.Reimbursement is determined by various factors, including the procedures performed, the place of service, and payer-specific rules.
- Global Days: Not applicable to ICD-10 codes. Global days are associated with surgical procedures (CPT codes).
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10 codes.
- Fee Schedule: Not applicable to ICD-10 codes.
- Specialties:Orthopedics, Emergency Medicine
- Place of Service:Emergency Room - Hospital, Office, Urgent Care Facility, Inpatient Hospital, Outpatient Hospital