ICD Code S42.202A

ICD code S42.202A is an unspecified fracture of the upper end of the left humerus, specifically for the initial encounter of a closed fracture. This code is used when documenting a patient's first visit for treatment of this type of fracture, where the bone has not pierced the skin, and the exact nature of the fracture is not detailed.

1. Patient Presentation: The patient presents with symptoms indicative of a fracture in the upper arm, such as severe pain, swelling, and limited range of motion in the shoulder or upper arm area.

2. Physical Examination: Upon examination, there is noticeable tenderness, swelling, or deformity around the shoulder or upper arm, suggesting a fracture.

3. Imaging Confirmation: An X-ray, CT scan, or MRI confirms the presence of a fracture at the upper end of the left humerus. The fracture is identified as closed, meaning the skin is intact.

4. Initial Encounter: This is the first time the patient is being evaluated and treated for this specific fracture, indicating an initial encounter.

5. Lack of Specificity: The fracture cannot be classified into a more specific category due to insufficient detail or complexity in the fracture pattern, thus it remains unspecified.

6. Closed Fracture: The fracture is closed, meaning there is no open wound or break in the skin over the fracture site.

7. Left Side Specification: The fracture is specifically located on the left side of the body, affecting the left humerus.

By following these criteria, healthcare providers can accurately determine when to use this specific ICD code for documentation and billing purposes.

For the ICD code S42.202A, the relevant CPT codes that may be applicable for the treatment of an unspecified fracture of the upper end of the left humerus during the initial encounter for a closed fracture include:

1. 23600 - Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation.

2. 23605 - Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with manipulation.

3. 23615 - Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed.

4. 23616 - Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed; with proximal humeral prosthetic replacement.

These CPT codes are used to describe the various treatment approaches for managing fractures of the upper end of the humerus, depending on the specific clinical scenario and the treatment method employed. It is important for healthcare providers to select the appropriate CPT code based on the treatment rendered to ensure accurate billing and reimbursement.

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