ICD-10 Code S42.452A: Displaced lateral condyle fracture, left humerus

Key takeaways

ICD-10 Code S42.452A describes a displaced fracture of the lateral condyle of the left humerus, initial encounter for closed fracture.

The nondisplaced left-side counterpart is a different code, S42.455A. The sixth character encodes displacement and laterality together, so check both.

When the record does not say whether a fracture is displaced, Section I.C.19.c of the ICD-10-CM Official Guidelines codes it to displaced.

Category S42 offers seven 7th characters: A, B, D, G, K, P, and S. Character A applies only during active treatment.

Practice management software like Pabau validates ICD-10-CM and CPT combinations against payer edits before a claim leaves the practice.

Lateral condyle fractures of the humerus are among the most mischaracterized upper extremity injuries in orthopedic coding. Displacement status alone splits this small family into two sets of three codes. Pick the wrong set and the claim is denied before a human reviewer ever sees it. ICD-10 Code S42.452A pins down four clinical specifics at once: displaced, lateral condyle, left humerus, initial encounter for a closed fracture.

This reference guide covers the official descriptor, a character-by-character breakdown of S42.452A, and all seven 7th character options in category S42. It also covers the sibling codes, billable status, documentation requirements, and the CPT codes most often paired with this diagnosis. It is written for coders, billers, and clinicians documenting distal humerus fractures in orthopedic or emergency settings.

ICD-10 Code S42.452A: definition and clinical meaning

ICD-10 Code S42.452A is a billable ICD-10-CM diagnosis code. Its full official descriptor is displaced fracture of lateral condyle of left humerus, initial encounter for closed fracture. You can confirm the wording in the CDC/NCHS ICD-10-CM web tool.

Four clinical specifics are encoded in this single code. The fracture is displaced, meaning the bone fragments have shifted out of anatomical alignment. It involves the lateral condyle, the outer bony prominence at the distal end of the humerus. It is on the left side, and the patient is presenting for active treatment.

The specific that matters most here is displacement. A nondisplaced fracture at the same site on the same side is S42.455A, not S42.452A. All four specifics need documentary support before this code goes on a claim.

Code breakdown: S42.452A character by character

Each character position in S42.452A carries a distinct clinical meaning. Reading the code from left to right helps coders catch specificity errors before submission.

The sixth character does two jobs at once, which is where most errors in this family start. Values 1, 2, and 3 are the displaced codes for the right, left, and unspecified side. Values 4, 5, and 6 are the nondisplaced codes in the same order.

Both defaults in this code come from one guideline. Per Section I.C.19.c of the ICD-10-CM Official Guidelines for Coding and Reporting, a fracture not documented as open or closed is coded to closed. A fracture not documented as displaced or nondisplaced is coded to displaced.

S42.452A therefore carries both defaults. It is the code to reach for when the record is silent on displacement, provided the site and the side are documented.

Understanding the 7th character: the full A to S set for S42.452

The 7th character is the most frequently misapplied element in fracture coding. Category S42 offers seven of them, and only one describes an initial encounter for a closed fracture. Selecting the wrong suffix at a follow-up visit is a common reason orthopedic claims get flagged for additional documentation.

The 7th character reflects the encounter type rather than the visit number. A patient seeing a second orthopedic surgeon for active surgical planning still uses the A suffix. The suffix changes to D once active treatment gives way to routine monitoring of healing.

Practice management software like Pabau runs code-level validation on every claim before it goes out. Its claims management software checks ICD-10-CM and CPT combinations against payer edits. An invalid pairing surfaces in the practice rather than in a remittance advice.

Related ICD-10-CM codes: the S42.45 family and neighboring distal humerus codes

S42.452A sits in a family of six codes at the S42.45 level. Three describe displaced fractures and three describe nondisplaced fractures, each running right, left, and unspecified. Choosing the wrong displacement set is the most common specificity error in this group.

S42.44 deserves a second look, because the code numbers sit next to each other while the anatomy does not. S42.44 is the medial epicondyle, on the inner side of the elbow. S42.45 is the lateral condyle, on the outer side.

When reviewing records for laterality, coders should not infer from the dominant hand or the mechanism of injury. The fracture side must be documented in the clinical note, the imaging report, or the operative report. The AAPC ICD-10-CM code lookup lets coders browse the full S42 range and verify descriptors quickly.

Billable status and ICD-10 Code S42.452A coding guidelines

S42.452A is a billable ICD-10-CM code. Its seven-character specificity satisfies CMS requirements for claims submission. The parent codes S42.4, S42.45, and S42.452 are not billable on their own. They act as header nodes in the tabular list, and S42.452 needs a 7th character before it can go on a claim.

Three rules from the ICD-10-CM Official Guidelines for Coding and Reporting matter most for this code.

• Displacement default: Section I.C.19.c states that a fracture not documented as displaced or nondisplaced is coded to displaced. S42.452A is therefore correct when the record leaves displacement open for the left lateral condyle.
• Open versus closed default: The same section codes a fracture to closed when the record does not say. Character A covers the closed presentation, and character B covers an open one.
• Active treatment definition: Section I.C.19.a applies character A to any encounter where the provider is actively treating the fracture. That includes surgery, a second-opinion consult with ongoing treatment planning, and cast application at another facility.

Accurate submission of ICD-10 Code S42.452A depends on clean claim construction. Pabau integrates with Claim.MD, our US clearinghouse partner, which checks ICD-10-CM and CPT codes against payer edits before a claim is transmitted. For a broader view of the revenue cycle, our guide to what medical billing involves covers the end-to-end process.

Clinical presentation and diagnosis of lateral condyle fractures

Lateral condyle fractures of the humerus present differently by age and mechanism. In children, the most common demographic, the usual mechanism is a fall on an outstretched hand or a direct lateral elbow impact. That produces a Salter-Harris type IV pattern at the lateral condyle physis.

In adults, the same mechanism more often produces a supracondylar or a wider distal humerus fracture. Isolated lateral condyle involvement is comparatively less common in that group. Clinical signs typically include lateral elbow swelling, point tenderness over the condyle, and reduced elbow extension.

Imaging usually starts with anteroposterior and lateral plain radiographs, with oblique views added to judge displacement. Displacement is the finding that changes both the code and the treatment plan. CT is sometimes ordered when plain films leave the degree of displacement unclear.

Documented displacement usually moves the case toward surgery. Displaced lateral condyle fractures are commonly treated with closed reduction and percutaneous pinning, or with open reduction and internal fixation. Nondisplaced fractures are more often casted, and they carry S42.455A rather than S42.452A.

Practices managing orthopedic caseloads can find workflow support in Pabau’s sports medicine software, which handles scheduling, clinical notes, and billing workflows for injury-focused practices.

Treatment, documentation, and humerus fracture ICD-10 code requirements

Documentation must support each element of S42.452A. An auditor reviewing a chart for this code expects to find four things recorded clearly. Those are the fracture site (lateral condyle), the affected side (left), the displacement status (displaced), and the encounter context (active treatment).

For surgical cases, the operative report is the primary documentation source. It should describe the fracture as displaced at the time of surgical inspection, along with the reduction method and the fixation used.

For cases managed in a cast, the office note should carry the imaging finding of displacement. It should also record the cast type, the duration, and the next imaging review date.

Practices operating physical therapy EMR workflows alongside orthopedic care benefit from shared documentation standards. Those standards carry the fracture diagnosis across the care episode, so the 7th character moves correctly as the patient goes from acute management to rehabilitation.

For an overview of how denial management in healthcare applies to musculoskeletal claims, that guide covers the denial patterns most relevant to trauma codes. Practices can also review the full list of denial codes in medical billing. That list shows which remittance codes signal a documentation problem rather than a coverage one.

Approximate synonyms and alternate descriptions

Clinical notes and operative reports rarely use the tabular wording. The descriptions below all map to S42.452A when they appear in documentation for an initial encounter with a closed fracture.

• Displaced fracture of the left lateral humeral condyle
• Left lateral condyle fracture of the humerus, displaced, initial visit
• Displaced left distal humerus lateral condyle fracture
• Closed displaced fracture of the lateral condyle, left elbow
• Left humeral lateral condyle fracture with fragment displacement
• Salter-Harris type IV fracture of the left lateral humeral condyle, displaced

Query the provider when a note says only “lateral condyle fracture, left” with no displacement statement. The guideline default sends you to S42.452A, but explicit documentation is what protects the claim in an audit. The CDC/NCHS ICD-10-CM web tool maps many of these terms through the alphabetic index.

Commonly paired CPT codes for S42.452A billing

ICD-10 Code S42.452A is a diagnosis code only. It has to be paired with a CPT procedure code that reflects what the provider did during the encounter. The codes below are the ones most often submitted alongside a displaced lateral condyle humerus fracture at an initial encounter.

Verify each pairing against payer-specific local coverage determinations before submission, because medical necessity requirements vary.

CPT pairings should be verified against current AMA CPT descriptors and payer LCDs before submission. The Check ICD-10 tool provides CPT-to-ICD-10 crosswalk data drawn from CMS and NCHS datasets. Practices submitting orthopedic claims electronically can also review what makes a clean claim to cut front-end rejections.

Cut rework on orthopedic fracture claims

Pabau’s claims management software checks ICD-10-CM and CPT combinations against payer edits before submission, then sends and tracks each claim through our Claim.MD integration. Spend less time reworking rejected orthopedic claims.

Book a demo

Common coding errors to avoid with S42.452A

Five mistakes account for most rejections and records requests on this code.

• Reaching for the nondisplaced sibling by habit: S42.455A is the nondisplaced left-side code. Assigning it to a displaced fracture understates severity and invites a records request.
• Reading the sixth character as laterality only: Values 1 to 3 are the displaced codes and values 4 to 6 are the nondisplaced ones. Each set runs right, left, unspecified.
• Confusing S42.44 with S42.45: S42.44 is the medial epicondyle and S42.45 is the lateral condyle. The numbers are adjacent, the anatomy is not.
• Leaving character A on follow-up claims: Character A belongs to active treatment only. Move to D, G, K, or P once the encounter is about how the fracture is healing.
• Defaulting to nondisplaced when the note is silent: Section I.C.19.c sends an undocumented displacement status to displaced, not to nondisplaced.

Subsequent encounter and sequela codes: S42.452D, S42.452K, and S42.452S

Encounter suffix errors are the most common coding mistake in fracture episode management. The move from S42.452A to S42.452D does not happen on a fixed date. It happens when clinical intent shifts from active treatment to routine monitoring of healing.

A practice that keeps S42.452A on every follow-up visit risks audit findings for systematic overcoding. The subsequent-encounter characters also carry clinical detail. G marks delayed healing, K marks nonunion, and P marks malunion.

S42.452S covers a different scenario. The original fracture has resolved, and the patient presents with a condition that is a late effect of it. Post-traumatic lateral elbow arthritis after a condyle fracture is a typical example. The sequela code accompanies the code for the residual condition rather than replacing it.

Pabau’s claims management software validates the diagnosis and procedure codes on a claim against payer edits before it is submitted. Coding decisions stay with the coder, but an invalid combination gets caught inside the practice.

For practices building out US billing infrastructure, our guide to medical billing compliance covers the audit risk areas most relevant to trauma codes. Two related humerus references are also worth a look. ICD-10 Code S42.332G covers a displaced oblique shaft fracture, and ICD-10 Code S42.399S covers a shaft fracture sequela.

Conclusion

Displaced lateral condyle fractures of the left humerus are a genuine coding challenge. The family holds six near-identical codes, the guideline default runs toward displaced, and the encounter suffix changes as the fracture heals. S42.452A becomes straightforward once the note states site, side, displacement, and encounter type.

Pabau’s integration with Claim.MD gives orthopedic and sports medicine practices a pre-submission check on diagnosis and procedure code combinations. To see how that works for fracture and trauma billing, book a demo with the Pabau team.

Continue your research

Need to understand how denial patterns affect trauma codes? Denial management in healthcare covers the remittance adjustment reason codes most commonly triggered by incomplete ICD-10-CM specificity.

Want a reference for musculoskeletal assessment tools used in fracture documentation? Ottawa ankle rules calculator illustrates how clinical decision tools inform documentation choices in trauma coding.

Looking for how revenue cycle management connects to accurate fracture coding? What is revenue cycle management explains how ICD-10 coding accuracy feeds directly into claims adjudication and cash flow.

Frequently asked questions