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2025 ICD-10-CM code S42.301D

Unspecified fracture of the humerus shaft in the right arm; subsequent encounter showing routine healing.

Use of this code requires that the initial fracture diagnosis be established. The subsequent encounter must demonstrate routine healing without any significant complications.If complications arise, the appropriate ICD-10-CM code reflecting the complication should be used instead.

Modifiers may be applicable depending on the specific circumstances of the visit and the services provided. Consult the appropriate modifier guidelines for details.

Medical necessity is established by the initial diagnosis of a humeral shaft fracture, the need for follow-up care to monitor healing, and the potential for complications if not properly monitored.Documentation should clearly support these elements.

The clinical responsibility includes initial diagnosis via patient history, physical examination, and imaging (X-rays, CT scan, MRI). Treatment might involve pain management (analgesics, NSAIDs), immobilization (splint, cast), and potentially surgery (open reduction and internal fixation). Follow-up assessments monitor healing progress and address any complications.

IMPORTANT:Related codes might include those specifying the type of fracture (e.g., displaced, nondisplaced), the location of the fracture (e.g., upper end, lower end), or the healing status (e.g., delayed healing, malunion, nonunion).Additional codes from Chapter 20 (External causes of morbidity) may be necessary to indicate the cause of the injury if not already documented.

In simple words: This code is for a follow-up visit after a broken upper arm bone (humerus). The bone is healing normally.

This code signifies a subsequent encounter for an unspecified fracture of the humerus shaft in the right arm, where the healing process is progressing as expected.The initial fracture's cause is not specified in this encounter.The code is used when the patient is undergoing routine follow-up for healing without complications like malunion, nonunion, or delayed healing.

Example 1: A patient presents for a routine follow-up appointment after a humeral shaft fracture. X-rays show the fracture healing without complications.Code S42.301D is used., A patient is seen for a check-up after a fall resulting in a right humerus fracture.Imaging shows the bone is healing correctly.Code S42.301D is used. , A patient, post-surgical fixation of a right humeral shaft fracture, attends a follow-up appointment. The surgeon notes the fracture is healing well. Code S42.301D is utilized.

* Patient history detailing the mechanism of injury.* Physical examination documenting findings.* Imaging studies (X-rays, CT scan, MRI as appropriate) showing the fracture and its healing progress.* Documentation of any treatment provided (e.g., pain management, immobilization, surgery).* Progress notes detailing healing status and the absence of complications.

** This code is specifically for subsequent encounters.The initial encounter would require a different code reflecting the acute fracture and its specific characteristics.Always ensure complete and accurate documentation of the patient's condition and treatment to ensure proper coding.

  • Payment Status: Active
  • Modifier TC rule: Not applicable to this diagnosis code.
  • Specialties:Orthopedics, Emergency Medicine, Family Medicine
  • Place of Service:Office, Hospital Outpatient, Urgent Care Facility
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