Version 2024

2024 ICD-10-CM Diagnosis Code S42.43

Fracture (avulsion) of lateral epicondyle of humerus

ICD-10-CM Code:
S42.43
ICD-10 Code for:
Fracture (avulsion) of lateral epicondyle of humerus
Is Billable?
Not Valid for Submission
Code Navigator:

Code Classification

  • Injury, poisoning and certain other consequences of external causes
    (S00–T88)
    • Injuries to the shoulder and upper arm
      (S40-S49)
      • Fracture of shoulder and upper arm
        (S42)

S42.43 is a non-specific and non-billable diagnosis code code, consider using a code with a higher level of specificity for a diagnosis of fracture (avulsion) of lateral epicondyle of humerus. The code is not specific and is NOT valid for the year 2024 for the submission of HIPAA-covered transactions. Category or Header define the heading of a category of codes that may be further subdivided by the use of 4th, 5th, 6th or 7th characters.

Specific Coding Applicable to Fracture (avulsion) of lateral epicondyle of humerus

Non-specific codes like S42.43 require more digits to indicate the appropriate level of specificity. Consider using any of the following ICD-10-CM codes with a higher level of specificity when coding for fracture (avulsion) of lateral epicondyle of humerus:

  • S42.431 for Displaced fracture (avulsion) of lateral epicondyle of right humerus - NON-BILLABLE CODE

  • Use S42.431A for initial encounter for closed fracture - BILLABLE CODE

  • Use S42.431B for initial encounter for open fracture - BILLABLE CODE

  • Use S42.431D for subsequent encounter for fracture with routine healing - BILLABLE CODE

  • Use S42.431G for subsequent encounter for fracture with delayed healing - BILLABLE CODE

  • Use S42.431K for subsequent encounter for fracture with nonunion - BILLABLE CODE

  • Use S42.431P for subsequent encounter for fracture with malunion - BILLABLE CODE

  • Use S42.431S for sequela - BILLABLE CODE

  • S42.432 for Displaced fracture (avulsion) of lateral epicondyle of left humerus - NON-BILLABLE CODE

  • Use S42.432A for initial encounter for closed fracture - BILLABLE CODE

  • Use S42.432B for initial encounter for open fracture - BILLABLE CODE

  • Use S42.432D for subsequent encounter for fracture with routine healing - BILLABLE CODE

  • Use S42.432G for subsequent encounter for fracture with delayed healing - BILLABLE CODE

  • Use S42.432K for subsequent encounter for fracture with nonunion - BILLABLE CODE

  • Use S42.432P for subsequent encounter for fracture with malunion - BILLABLE CODE

  • Use S42.432S for sequela - BILLABLE CODE

  • S42.433 for Displaced fracture (avulsion) of lateral epicondyle of unspecified humerus - NON-BILLABLE CODE

  • Use S42.433A for initial encounter for closed fracture - BILLABLE CODE

  • Use S42.433B for initial encounter for open fracture - BILLABLE CODE

  • Use S42.433D for subsequent encounter for fracture with routine healing - BILLABLE CODE

  • Use S42.433G for subsequent encounter for fracture with delayed healing - BILLABLE CODE

  • Use S42.433K for subsequent encounter for fracture with nonunion - BILLABLE CODE

  • Use S42.433P for subsequent encounter for fracture with malunion - BILLABLE CODE

  • Use S42.433S for sequela - BILLABLE CODE

  • S42.434 for Nondisplaced fracture (avulsion) of lateral epicondyle of right humerus - NON-BILLABLE CODE

  • Use S42.434A for initial encounter for closed fracture - BILLABLE CODE

  • Use S42.434B for initial encounter for open fracture - BILLABLE CODE

  • Use S42.434D for subsequent encounter for fracture with routine healing - BILLABLE CODE

  • Use S42.434G for subsequent encounter for fracture with delayed healing - BILLABLE CODE

  • Use S42.434K for subsequent encounter for fracture with nonunion - BILLABLE CODE

  • Use S42.434P for subsequent encounter for fracture with malunion - BILLABLE CODE

  • Use S42.434S for sequela - BILLABLE CODE

  • S42.435 for Nondisplaced fracture (avulsion) of lateral epicondyle of left humerus - NON-BILLABLE CODE

  • Use S42.435A for initial encounter for closed fracture - BILLABLE CODE

  • Use S42.435B for initial encounter for open fracture - BILLABLE CODE

  • Use S42.435D for subsequent encounter for fracture with routine healing - BILLABLE CODE

  • Use S42.435G for subsequent encounter for fracture with delayed healing - BILLABLE CODE

  • Use S42.435K for subsequent encounter for fracture with nonunion - BILLABLE CODE

  • Use S42.435P for subsequent encounter for fracture with malunion - BILLABLE CODE

  • Use S42.435S for sequela - BILLABLE CODE

  • S42.436 for Nondisplaced fracture (avulsion) of lateral epicondyle of unspecified humerus - NON-BILLABLE CODE

  • Use S42.436A for initial encounter for closed fracture - BILLABLE CODE

  • Use S42.436B for initial encounter for open fracture - BILLABLE CODE

  • Use S42.436D for subsequent encounter for fracture with routine healing - BILLABLE CODE

  • Use S42.436G for subsequent encounter for fracture with delayed healing - BILLABLE CODE

  • Use S42.436K for subsequent encounter for fracture with nonunion - BILLABLE CODE

  • Use S42.436P for subsequent encounter for fracture with malunion - BILLABLE CODE

  • Use S42.436S for sequela - BILLABLE CODE

Coding Guidelines

The principles of multiple coding of injuries should be followed in coding fractures. Fractures of specified sites are coded individually by site nd the level of detail furnished by medical record content.

A fracture not indicated as open or closed should be coded to closed. A fracture not indicated whether displaced or not displaced should be coded to displaced.

Initial vs. Subsequent Encounter for Fractures

Traumatic fractures are coded using the appropriate 7th character for initial encounter (A, B, C) for each encounter where the patient is receiving active treatment for the fracture. The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.

Fractures are coded using the appropriate 7th character for subsequent care for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase.

Care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes.

Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate 7th character for subsequent care with nonunion (K, M, N,) or subsequent care with malunion (P, Q, R).

Malunion/nonunion: The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.

The open fracture designations in the assignment of the 7th character for fractures of the forearm, femur and lower leg, including ankle are based on the Gustilo open fracture classification. When the Gustilo classification type is not specified for an open fracture, the 7th character for open fracture type I or II should be assigned (B, E, H, M, Q).

Index to Diseases and Injuries References

The following annotation back-references for this diagnosis code are found in the injuries and diseases index. The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10-CM code(s).

Patient Education


Elbow Injuries and Disorders

Your elbow joint is made up of bone, cartilage, ligaments and fluid. Muscles and tendons help the elbow joint move. When any of these structures is hurt or diseased, you have elbow problems.

Many things can make your elbow hurt. A common cause is tendinitis, an inflammation or injury to the tendons that attach muscle to bone. Tendinitis of the elbow is a sports injury, often from playing tennis or golf. You may also get tendinitis from overuse of the elbow.

Other causes of elbow pain include sprains and strains, fractures (broken bones), dislocations, bursitis, and arthritis. Treatment depends on the cause.


[Learn More in MedlinePlus]

Fractures

A fracture is a break, usually in a bone. If the broken bone punctures the skin, it is called an open or compound fracture. Fractures commonly happen because of car accidents, falls, or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Overuse can cause stress fractures, which are very small cracks in the bone.

Symptoms of a fracture are:

  • Intense pain
  • Deformity - the limb looks out of place
  • Swelling, bruising, or tenderness around the injury
  • Numbness and tingling
  • Problems moving a limb

You need to get medical care right away for any fracture. An x-ray can tell if your bone is broken. You may need to wear a cast or splint. Sometimes you need surgery to put in plates, pins or screws to keep the bone in place.


[Learn More in MedlinePlus]

Code History

  • FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
  • FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
  • FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
  • FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.