2022 ICD-10-CM Code S42.26

Fracture of lesser tuberosity of humerus

Version 2021

Not Valid for Submission

ICD-10:S42.26
Short Description:Fracture of lesser tuberosity of humerus
Long Description:Fracture of lesser tuberosity of humerus

Code Classification

  • Injury, poisoning and certain other consequences of external causes (S00–T98)
    • Injuries to the shoulder and upper arm (S40-S49)
      • Fracture of shoulder and upper arm (S42)

S42.26 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 of lesser tuberosity of humerus. The code is not specific and is NOT valid for the year 2022 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.

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).

Specific Coding for Fracture of lesser tuberosity of humerus

Non-specific codes like S42.26 require more digits to indicate the appropriate level of specificity. Consider using any of the following ICD-10 codes with a higher level of specificity when coding for fracture of lesser tuberosity of humerus:

  • NON-BILLABLE CODE - S42.261 for Displaced fracture of lesser tuberosity of right humerus
  • BILLABLE CODE - Use S42.261A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.261B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.261D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.261G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.261K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.261P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.261S for sequela
  • NON-BILLABLE CODE - S42.262 for Displaced fracture of lesser tuberosity of left humerus
  • BILLABLE CODE - Use S42.262A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.262B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.262D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.262G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.262K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.262P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.262S for sequela
  • NON-BILLABLE CODE - S42.263 for Displaced fracture of lesser tuberosity of unspecified humerus
  • BILLABLE CODE - Use S42.263A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.263B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.263D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.263G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.263K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.263P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.263S for sequela
  • NON-BILLABLE CODE - S42.264 for Nondisplaced fracture of lesser tuberosity of right humerus
  • BILLABLE CODE - Use S42.264A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.264B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.264D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.264G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.264K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.264P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.264S for sequela
  • NON-BILLABLE CODE - S42.265 for Nondisplaced fracture of lesser tuberosity of left humerus
  • BILLABLE CODE - Use S42.265A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.265B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.265D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.265G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.265K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.265P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.265S for sequela
  • NON-BILLABLE CODE - S42.266 for Nondisplaced fracture of lesser tuberosity of unspecified humerus
  • BILLABLE CODE - Use S42.266A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.266B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.266D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.266G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.266K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.266P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.266S for sequela

Index to Diseases and Injuries

The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10 code(s). The following references for the code S42.26 are found in the index:

Information for Patients


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

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]

Shoulder Injuries and Disorders

Your shoulder joint is composed of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). Your shoulders are the most movable joints in your body. They can also be unstable because the ball of the upper arm is larger than the shoulder socket that holds it. To remain in a stable or normal position, the shoulder must be anchored by muscles, tendons, and ligaments.

Because your shoulder can be unstable, it can be easily injured. Common problems include

Health care providers diagnose shoulder problems by using your medical history, a physical exam, and imaging tests.

Often, the first treatment for shoulder problems is RICE. This stands for Rest, Ice, Compression, and Elevation. Other treatments include exercise and medicines to reduce pain and swelling. If those don't work, you may need surgery.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases


[Learn More in MedlinePlus]

Code History

  • 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 (First year ICD-10-CM implemented into the HIPAA code set)