2025 ICD-10-CM code S42.202A
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Injury - Fracture of upper end of humerus Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88) Feed
Unspecified fracture of the upper end of the left humerus, initial encounter for a closed fracture.
Modifiers may be applicable depending on the circumstances of the service provided.For example, modifiers might be used to indicate the place of service or the type of anesthesia used during any surgical intervention.
Medical necessity for treatment of a fractured humerus is established by the presence of a fracture confirmed by imaging, causing pain, limitation of function, and potential for complications if left untreated. Treatment is medically necessary to restore anatomical integrity, relieve pain, and prevent complications.
Diagnosis involves patient history, physical exam (assessing wound, nerves, blood supply), imaging (X-rays, CT, MRI), and potentially lab tests. Treatment may include analgesics, corticosteroids, muscle relaxants, NSAIDs, thrombolytics/anticoagulants, calcium/vitamin D supplements, immobilization (splint/cast), rest, RICE (rest, ice, compression, elevation), physical therapy, and potentially surgery (ORIF).
- Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88)
- S40-S49 (Injuries to the shoulder and upper arm)
In simple words: This code means a broken upper left arm bone, where the skin isn't broken.It's the first time this injury is being documented medically.
This code classifies an unspecified fracture of the upper end of the left humerus, during the initial encounter, where the fracture is closed (meaning the bone is broken but the skin is not pierced).The location is the proximal (upper) end of the humerus, and the specific type of fracture is not specified. This could include fractures of the anatomical neck or articular head of the humerus.The seventh character 'A' specifies this as an initial encounter for a closed fracture.Further codes may be necessary to specify the cause of injury (from Chapter 20), and any retained foreign body (using Z18.-).
Example 1: A patient falls on their outstretched left arm, resulting in a closed fracture of the upper humerus. This is their first visit for this injury., A patient is involved in a motor vehicle accident and sustains a closed fracture of their left proximal humerus. This is their first medical encounter for this specific fracture., During a sporting event, a patient suffers a closed fracture of the left upper humerus.The fracture is not displaced significantly, and this is the initial visit for treatment.
Detailed patient history of the injury mechanism, physical examination findings (including assessment of neurovascular status), and imaging reports (X-rays, CT scan, or MRI) are essential for accurate coding.Documentation should clearly indicate that this is the initial encounter for this specific fracture.
** The seventh character in this code is crucial.'A' denotes the initial encounter for a closed fracture. Other seventh characters represent subsequent encounters or different fracture statuses.
- Payment Status: Active
- Specialties:Orthopedics, Emergency Medicine
- Place of Service:Emergency Room - Hospital, Office, Outpatient Hospital