ICD-10-CM Billable Code

S42.26

Fracture of lesser tuberosity of humerus

Clinical Classification Guidelines

Medical Intelligence & Overview

A fracture of the lesser tuberosity of the humerus is a break in the small bony prominence located on the upper part of the upper arm bone (humerus). This condition typically results from direct trauma or a significant force applied to the shoulder area. The lesser tuberosity serves as an attachment point for muscles involved in shoulder movement, making such fractures particularly impactful on shoulder function and mobility.

Causes & Symptoms

Clinical Causes: Direct blow or trauma to the shoulder, such as falls or sports injuries Sudden, forceful shoulder movements or dislocations High-impact accidents, like car crashes Repetitive stress or overuse in some cases

Key Symptoms: Pain in the shoulder area, especially during movement Swelling and tenderness around the shoulder Limited range of motion in the shoulder joint Weakness in shoulder and arm muscles Visible deformity or bruising in severe cases

Diagnostic & Treatment

Diagnosis Path: Diagnosing a fracture of the lesser tuberosity of the humerus involves a combination of physical examination and imaging tests. A healthcare provider will evaluate shoulder movement, tenderness, and stability. Imaging techniques such as X-rays are essential to confirm the presence and extent of the fracture. In some cases, advanced imaging like MRI may be used to assess associated soft tissue injuries or subtle fractures that are not visible on X-rays.

Treatment Protocols: Treatment options depend on the severity and location of the fracture. Common approaches include:

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.

Clinical Advice & FAQs

Billing Guidance

Is S42.26 a billable ICD-10 code?
Yes, S42.26 is a specific, billable code that can be used to indicate a diagnosis for reimbursement purposes.

Documentation

How do I report S42.26?
Clinical documentation must specify the nature of Fracture of lesser tuberosity of humerus and any associated comorbidities for accurate reporting.

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