ICD-10 S42.463P

Description

Displaced fracture of medial condyle of unspecified humerus, subsequent encounter for fracture with malunion

Common Specialties

Emergency Medicine, Orthopedics

Documentation Requirements

• Document clinical indications and clear medical necessity supporting the encounter or procedure.
• Ensure complete provider signatures, credentials, date, and specific place of service (POS).
• Verify documentation strictly supports code specificity to prevent downcoding or claim denials.

Billing & Coding Tips

• Verify current payer fee schedules, NCCI edits, and Medically Unlikely Edits (MUEs).
• Append correct modifiers (e.g., 25, 59, 26, TC) where distinct procedural services or components apply.
• Confirm pre-authorization rules with Medicare, Medicaid, and commercial plans before submission.

Related Codes

---

Quantum Health Services provides full-cycle revenue cycle management and medical billing services nationwide. This code reference is for educational purposes; always verify official payer policies. CPT© descriptors require proper AMA licensing.