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ICD-10 Guide
ICD-10 CodesS42.13

S42.13

Billable

Fracture of coracoid process

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/24/2025

Code Description

ICD-10 S42.13 is a billable code used to indicate a diagnosis of fracture of coracoid process.

Key Diagnostic Point:

The coracoid process is a small hook-like structure on the scapula that serves as an attachment point for several muscles and ligaments. A fracture of the coracoid process is relatively uncommon and often occurs in conjunction with shoulder dislocations or fractures of the proximal humerus. This injury can result from direct trauma, such as a fall onto an outstretched arm or a direct blow to the shoulder. Clinically, patients may present with localized pain, swelling, and limited range of motion in the shoulder. Diagnosis is typically confirmed through imaging studies, such as X-rays or CT scans, which can reveal the fracture's location and any associated injuries. Treatment may vary based on the fracture's severity and associated injuries, ranging from conservative management with rest and physical therapy to surgical intervention for more complex cases. Surgical options may include fixation of the fracture or repair of associated rotator cuff injuries. Proper coding for this condition is essential for accurate billing and reimbursement, as it can impact the overall management of shoulder injuries.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in associated injuries (e.g., dislocations, humeral fractures)
  • Need for precise documentation of fracture type and location
  • Potential for concurrent rotator cuff injuries
  • Variability in treatment approaches (conservative vs. surgical)

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to document associated injuries
  • Incorrect coding of fracture type (e.g., displaced vs. non-displaced)
  • Lack of follow-up documentation post-treatment

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and post-operative notes are essential for accurate coding.

Common Clinical Scenarios

Fractures occurring in conjunction with shoulder dislocations or rotator cuff tears.

Billing Considerations

Documentation must clearly indicate the type of fracture and any surgical interventions performed.

Physical Therapy

Documentation Requirements

Progress notes detailing the patient's rehabilitation progress and response to therapy.

Common Clinical Scenarios

Patients undergoing rehabilitation post-fracture or surgical repair.

Billing Considerations

Therapy notes should correlate with the surgical procedure and diagnosis for accurate billing.

Coding Guidelines

Inclusion Criteria

Use S42.13 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture type, location, and any associated injuries
  • Include relevant external cause codes if applicable

Exclusion Criteria

Do NOT use S42.13 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, surgical

Clinical Scenario

Used for surgical repair of associated rotator cuff injuries during coracoid fracture surgery.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the correlation between the fracture and surgical intervention.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, including the coracoid process, improving the accuracy of billing and clinical data collection.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including the coracoid process, improving the accuracy of billing and clinical data collection.

Reimbursement & Billing Impact

billing and clinical data collection.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common causes of a coracoid process fracture?

Common causes include direct trauma from falls, sports injuries, or accidents that involve a forceful impact to the shoulder.

How is a coracoid process fracture treated?

Treatment can range from conservative management with rest and physical therapy to surgical intervention, depending on the fracture's severity and associated injuries.