ICD-10-CM Billable Code

S42.264

Nondisplaced fracture of lesser tuberosity of right humerus

Clinical Classification Guidelines

Medical Intelligence & Overview

A nondisplaced fracture of the lesser tuberosity of the right humerus is a type of shoulder injury where a small break occurs in the bony prominence called the lesser tuberosity, located at the upper part of the upper arm bone (humerus). In a nondisplaced fracture, the broken bone fragments remain aligned and have not moved out of their normal position. This condition typically results from trauma or a sudden injury, such as a fall or direct blow to the shoulder. Recognizing this injury early is important for proper treatment and healing.

Causes & Symptoms

Clinical Causes: Falls onto the shoulder or outstretched hand Direct blow or trauma to the shoulder area Sports injuries involving shoulder impact Motor vehicle accidents Overuse or stress injuries in athletes or laborers

Key Symptoms: Localized shoulder pain, especially at the front or side Pain worsened by shoulder movement or lifting the arm Tenderness around the front of the shoulder Limited range of motion in the shoulder Swelling, redness, or bruising in the affected area Weakness or difficulty in arm movements

Diagnostic & Treatment

Diagnosis Path: Diagnosing a nondisplaced fracture of the lesser tuberosity involves a combination of physical examination and imaging studies. The doctor typically assesses shoulder movement, tenderness, and any signs of swelling or deformity. Imaging tests primarily include X-rays, which are used to visualize the bone structure and confirm that the fracture is nondisplaced. Sometimes, MRI or CT scans may be ordered for more detailed assessment, especially if soft tissue injuries are suspected or X-rays are inconclusive.

Treatment Protocols: Rest and immobilization of the shoulder using a brace or sling Ice application to reduce swelling and pain Pain relievers such as acetaminophen or NSAIDs as recommended by a healthcare provider Gradual physical therapy to restore mobility, strength, and function once initial healing occurs Surgical intervention is rarely needed unless there are associated injuries or complications that require fixation

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 S42.264 a billable ICD-10 code?
Yes, S42.264 is a specific, billable code that can be used to indicate a diagnosis for reimbursement purposes.

Documentation

How do I report S42.264?
Clinical documentation must specify the nature of Nondisplaced fracture of lesser tuberosity of right humerus and any associated comorbidities for accurate reporting.

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