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v1.0.0
ICD-10 Guide
ICD-10 CodesS42.00

S42.00

Billable

Fracture of unspecified part of clavicle

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

Code Description

ICD-10 S42.00 is a billable code used to indicate a diagnosis of fracture of unspecified part of clavicle.

Key Diagnostic Point:

A fracture of the clavicle, commonly known as the collarbone, can occur due to various mechanisms of injury, including falls, direct blows, or sports-related incidents. The clavicle connects the arm to the body and plays a crucial role in shoulder stability and function. Fractures can occur at different locations along the clavicle, including the medial (inner), middle, and lateral (outer) thirds. An unspecified fracture indicates that the exact location of the fracture is not documented, which can complicate treatment and recovery. Symptoms typically include pain, swelling, and difficulty moving the shoulder. Diagnosis is usually confirmed through physical examination and imaging studies such as X-rays. Treatment may vary based on the severity of the fracture, with options ranging from conservative management, such as immobilization with a sling, to surgical intervention in cases of displacement or instability. Understanding the nuances of this code is essential for accurate billing and appropriate patient care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Lack of specificity in the documentation regarding the fracture location.
  • Variability in treatment approaches based on fracture type.
  • Potential for misclassification with other shoulder injuries.
  • Need for comprehensive documentation to support the diagnosis.

Audit Risk Factors

  • Inadequate documentation of fracture details.
  • Failure to specify the mechanism of injury.
  • Inconsistent coding with treatment provided.
  • Lack of follow-up documentation on healing progress.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on fracture location, mechanism of injury, and treatment plan.

Common Clinical Scenarios

Patients presenting with shoulder pain after a fall or sports injury.

Billing Considerations

Ensure imaging results are included in the documentation to support the diagnosis.

Emergency Medicine

Documentation Requirements

Comprehensive assessment notes, including initial evaluation and imaging results.

Common Clinical Scenarios

Patients with acute shoulder injuries presenting to the emergency department.

Billing Considerations

Document the patient's history and any immediate interventions performed.

Coding Guidelines

Inclusion Criteria

Use S42.00 When
  • According to ICD
  • 10 coding guidelines, fractures should be coded based on the specific site and type of fracture
  • 00 is used when the specific part of the clavicle is not documented
  • Coders should ensure that the documentation supports the use of this code and consider the context of the injury

Exclusion Criteria

Do NOT use S42.00 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23630CPT Code

Open treatment of clavicular fracture

Clinical Scenario

Used when surgical intervention is required for a displaced clavicle fracture.

Documentation Requirements

Operative report detailing the procedure performed and the condition of the fracture.

Specialty Considerations

Orthopedic surgeons should ensure that all surgical notes are comprehensive and include pre-operative and post-operative assessments.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding fractures, which can improve patient care and billing accuracy. However, the unspecified nature of S42.00 can lead to challenges in documentation and coding consistency.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding fractures, which can improve patient care and billing accuracy. However, the unspecified nature of S42.00 can lead to challenges in documentation and coding consistency.

Reimbursement & Billing Impact

billing accuracy. However, the unspecified nature of S42.00 can lead to challenges in documentation and coding consistency.

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

When should I use S42.00 instead of a more specific code?

S42.00 should be used when the documentation does not specify the exact location of the clavicle fracture. If the specific part is documented, a more specific code should be used.