2022 ICD-10-CM Code S42.40

Unspecified fracture of lower end of humerus

Version 2021

Not Valid for Submission

ICD-10:S42.40
Short Description:Unspecified fracture of lower end of humerus
Long Description:Unspecified fracture of lower end 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)

S42.40 is a non-specific and non-billable diagnosis code code, consider using a code with a higher level of specificity for a diagnosis of unspecified fracture of lower end 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.

Unspecified diagnosis codes like S42.40 are acceptable when clinical information is unknown or not available about a particular condition. Although a more specific code is preferable, unspecified codes should be used when such codes most accurately reflect what is known about a patient's condition. Specific diagnosis codes should not be used if not supported by the patient's medical record.

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 Unspecified fracture of lower end of humerus

Non-specific codes like S42.40 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 unspecified fracture of lower end of humerus:

  • NON-BILLABLE CODE - S42.401 for Unspecified fracture of lower end of right humerus
  • BILLABLE CODE - Use S42.401A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.401B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.401D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.401G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.401K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.401P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.401S for sequela
  • NON-BILLABLE CODE - S42.402 for Unspecified fracture of lower end of left humerus
  • BILLABLE CODE - Use S42.402A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.402B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.402D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.402G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.402K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.402P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.402S for sequela
  • NON-BILLABLE CODE - S42.409 for Unspecified fracture of lower end of unspecified humerus
  • BILLABLE CODE - Use S42.409A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.409B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.409D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.409G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.409K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.409P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.409S for sequela

Tabular List of Diseases and Injuries

The Tabular List of Diseases and Injuries is a list of ICD-10 codes, organized "head to toe" into chapters and sections with coding notes and guidance for inclusions, exclusions, descriptions and more. The following references are applicable to the code S42.40:


Inclusion Terms

Inclusion Terms
These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.

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 S42.40 are found in the index:

Information for Patients


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

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 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)