2025 ICD-10-CM code S42.301G
Unspecified fracture of shaft of humerus, right arm, subsequent encounter for fracture with delayed healing.
Medical necessity must be established for each encounter by documenting the need for continued care and treatment due to delayed healing.The documentation should clearly demonstrate the ongoing need for medical intervention and justify the services provided.
The physician is responsible for assessing the fracture, determining the appropriate treatment, monitoring the healing process, and managing any complications.This includes physical examination, ordering and interpreting imaging studies, prescribing medication for pain and inflammation, possibly recommending immobilization or surgery, and providing appropriate referrals for physical therapy or other rehabilitation services.
- Injury, poisoning and certain other consequences of external causes (S00-T88)
- S42.301 - Unspecified fracture of shaft of humerus, right armS42.301A - initial encounter for closed fractureS42.301B - initial encounter for open fractureS42.301D - subsequent encounter for fracture with routine healingS42.301G - subsequent encounter for fracture with delayed healingS42.301K - subsequent encounter for fracture with nonunionS42.301P - subsequent encounter for fracture with malunionS42.301S - sequela
In simple words: This code indicates a follow-up visit for a broken upper right arm bone (humerus) that is not healing as quickly as it should.
This code describes a fracture of the shaft of the right humerus, which is the long bone in the upper arm, where the cause is unspecified.This is for a subsequent encounter, meaning the patient has been seen before for this injury, and the fracture is healing slower than expected (delayed healing).
Example 1: A patient initially presented with a closed, unspecified fracture of the right humeral shaft. After several weeks, follow-up imaging shows the fracture is healing slower than expected, indicating delayed healing., A patient was involved in a motor vehicle accident and sustained multiple injuries, including an unspecified fracture of the right humeral shaft.They are now being seen for a follow-up visit, and the arm fracture shows signs of delayed healing.Other injuries are also being addressed., An elderly patient fell and sustained an unspecified fracture of their right humerus. Due to underlying medical conditions and poor nutrition, the healing process is delayed, and the patient presents for a follow-up evaluation and treatment.
Documentation should include details of the initial injury, subsequent treatment provided, progress of healing, complications if any, and the reason for the delayed healing. Imaging reports and physician notes should support the diagnosis of delayed healing.
** This code is for subsequent encounters, so it would not be used for the initial visit when the fracture was first diagnosed. The documentation should support the delayed healing status.
- Specialties:Orthopedic Surgery, Emergency Medicine, Family Medicine, General Practice
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Emergency Room - Hospital