2025 ICD-10-CM code S42
Fracture of shoulder and upper arm. A fracture not indicated as displaced or nondisplaced should be coded to displaced. A fracture not indicated as open or closed should be coded to closed.
Yes, modifiers can be applied to specify the laterality (right or left) and other details of the fracture.
Medical necessity for treatment is established by the presence of a fracture confirmed by imaging. The specific treatment (e.g., sling, surgery) is medically necessary based on the type and severity of the fracture and the clinical judgment of the provider.
Providers diagnose the fracture based on patient history, physical examination, and imaging (X-rays, MRI, CT). Treatment depends on the type and severity of the fracture and may include immobilization, pain management, physical therapy, and/or surgery.
- Injury, poisoning and certain other consequences of external causes (S00-T88)
- Injuries to the shoulder and upper arm (S40-S49)
In simple words: A shoulder and upper arm fracture refers to a break in the bones of the shoulder joint and upper arm. This can happen due to high-impact injuries like falls, car accidents, or sports injuries.It can cause pain, difficulty moving the arm, swelling, bruising, and limited range of motion. Doctors diagnose this through physical examination and imaging tests like X-rays, MRIs, and CT scans. Treatment can range from applying ice and wearing a sling to surgery for more severe fractures, along with pain medication and physical therapy.
Fracture of shoulder and upper arm.Includes injuries to the axilla and scapular region.A fracture not indicated as displaced or nondisplaced should be coded to displaced. A fracture not indicated as open or closed should be coded to closed.
Example 1: A 20-year-old male falls while skateboarding and sustains a closed, displaced fracture of the proximal humerus. This would be coded as S42.2., A 70-year-old female falls at home and sustains a closed, nondisplaced fracture of the surgical neck of the humerus. This would be coded as S42.2., A 35-year-old male is involved in a motor vehicle accident and sustains an open, comminuted fracture of the shaft of the humerus.This would be coded as S42.3.
Documentation should include details of the injury mechanism, physical examination findings (e.g., swelling, bruising, deformity, limited range of motion), and imaging results.The type of fracture (open vs. closed, displaced vs. nondisplaced) and the specific bone involved should be clearly documented.
** Excludes1: traumatic amputation of shoulder and upper arm (S48.-)Excludes2: periprosthetic fracture around internal prosthetic shoulder joint (M97.3)birth trauma (P10-P15)obstetric trauma (O70-O71)burns and corrosions (T20-T32)frostbite (T33-T34)injuries of elbow (S50-S59)insect bite or sting, venomous (T63.4)
- Specialties:Orthopedic Surgery, Emergency Medicine, Family Medicine
- Place of Service:Office, Home, Inpatient Hospital, On Campus-Outpatient Hospital, Emergency Room - Hospital, Independent Clinic, Federally Qualified Health Center, Other Place of Service