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ICD-10 Guide
ICD-10 CodesS42.001

S42.001

Billable

Fracture of unspecified part of right clavicle

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

Code Description

ICD-10 S42.001 is a billable code used to indicate a diagnosis of fracture of unspecified part of right clavicle.

Key Diagnostic Point:

The fracture of the right clavicle, an essential bone in the shoulder girdle, can occur due to various mechanisms, including falls, direct trauma, or sports injuries. This fracture is classified as 'unspecified' when the exact location or type of fracture (e.g., midshaft, distal, or proximal) is not documented. Clinically, patients may present with shoulder pain, swelling, and limited range of motion. Physical examination often reveals tenderness over the clavicle, and imaging studies, such as X-rays, are crucial for diagnosis. Treatment typically involves conservative management, including immobilization with a sling, pain management, and physical therapy. In some cases, surgical intervention may be necessary, particularly if there is significant displacement or associated injuries to the surrounding structures, such as the rotator cuff or humerus. Understanding the nuances of this fracture is essential for accurate coding and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and locations
  • Need for precise documentation of injury mechanism
  • Potential for associated injuries (e.g., shoulder dislocations)
  • Differentiation from other shoulder injuries

Audit Risk Factors

  • Inadequate documentation of fracture type
  • Failure to note associated injuries
  • Inconsistent coding of treatment modalities
  • Lack of clarity in the mechanism of injury

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging results, and follow-up assessments.

Common Clinical Scenarios

Fractures requiring surgical fixation, management of associated shoulder injuries.

Billing Considerations

Ensure documentation reflects the specific type of fracture and any surgical interventions performed.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessment of functional limitations and rehabilitation goals.

Common Clinical Scenarios

Post-fracture rehabilitation, management of pain and mobility issues.

Billing Considerations

Document the impact of the fracture on daily activities and progress in therapy.

Coding Guidelines

Inclusion Criteria

Use S42.001 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the fracture type, mechanism of injury, and any associated conditions

Exclusion Criteria

Do NOT use S42.001 When
  • Exclude codes for specific types of clavicle fractures when applicable

Related ICD-10 Codes

Related CPT Codes

23630CPT Code

Open treatment of clavicular fracture

Clinical Scenario

Used when surgical intervention is performed for a clavicle fracture.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should ensure that the procedure aligns with the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of data collection and reimbursement processes. S42.001 serves as a catch-all for unspecified fractures, emphasizing the need for thorough documentation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of data collection and reimbursement processes. S42.001 serves as a catch-all for unspecified fractures, emphasizing the need for thorough documentation.

Reimbursement & Billing Impact

reimbursement processes. S42.001 serves as a catch-all for unspecified fractures, emphasizing the need for thorough documentation.

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 should I document to support the use of S42.001?

Document the mechanism of injury, clinical findings, imaging results, and any treatment provided. Ensure clarity in the documentation to avoid ambiguity.