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ICD-10 Guide
ICD-10 CodesS42.013

S42.013

Billable

Anterior displaced fracture of sternal end of unspecified clavicle

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

Code Description

ICD-10 S42.013 is a billable code used to indicate a diagnosis of anterior displaced fracture of sternal end of unspecified clavicle.

Key Diagnostic Point:

The anterior displaced fracture of the sternal end of the clavicle is a specific type of fracture that occurs at the junction where the clavicle meets the sternum. This injury is often the result of direct trauma, such as a fall or a collision, and can lead to significant pain, swelling, and limited range of motion in the shoulder. Clinically, patients may present with a visible deformity, tenderness over the fracture site, and difficulty lifting the arm. Diagnosis is typically confirmed through imaging studies, such as X-rays, which can reveal the fracture's displacement and any associated injuries. Treatment may vary based on the severity of the fracture, with options ranging from conservative management, including immobilization and physical therapy, to surgical intervention for more severe cases. Surgical options may include open reduction and internal fixation (ORIF) to realign the bone fragments and stabilize the fracture. Rehabilitation is crucial for restoring function and strength to the shoulder joint following treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture presentation and severity
  • Need for precise documentation of displacement and location
  • Potential for associated injuries to the shoulder or thoracic region
  • Differentiation from other types of clavicular fractures

Audit Risk Factors

  • Inadequate documentation of fracture details
  • Failure to specify laterality or displacement
  • Misclassification of fracture type
  • Inconsistent coding of associated injuries

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging reports, and follow-up assessments are essential for accurate coding.

Common Clinical Scenarios

Surgical repair of displaced clavicular fractures, management of complications such as nonunion or malunion.

Billing Considerations

Ensure that all surgical interventions and post-operative care are thoroughly documented to support the coding.

Physical Therapy

Documentation Requirements

Progress notes detailing the patient's rehabilitation progress and any modifications to the treatment plan.

Common Clinical Scenarios

Rehabilitation following surgical repair of clavicular fractures, management of shoulder mobility and strength.

Billing Considerations

Document specific functional limitations and goals to support the need for therapy services.

Coding Guidelines

Inclusion Criteria

Use S42.013 When
  • According to ICD
  • 10 coding guidelines, S42
  • 013 should be used when the fracture is confirmed and documented as anteriorly displaced
  • Coders must ensure that the fracture is not classified under other codes for clavicular fractures and that all relevant details are captured in the medical record

Exclusion Criteria

Do NOT use S42.013 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 an anterior displaced fracture.

Documentation Requirements

Operative report detailing the procedure performed and any complications.

Specialty Considerations

Orthopedic surgeons must ensure that all surgical details are documented to support the coding.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding fractures, including those of the clavicle. S42.013 provides a clear distinction for anterior displaced fractures, which aids in accurate billing and improved patient care management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding fractures, including those of the clavicle. S42.013 provides a clear distinction for anterior displaced fractures, which aids in accurate billing and improved patient care management.

Reimbursement & Billing Impact

billing and improved patient care management.

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 is the difference between S42.013 and S42.012?

S42.013 refers specifically to an anterior displaced fracture of the sternal end of the clavicle, while S42.012 pertains to a displaced fracture of the acromial end of the clavicle. Accurate coding requires specifying the fracture's location.