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ICD-10 Guide
ICD-10 CodesS42.02

S42.02

Billable

Fracture of shaft of clavicle

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

Code Description

ICD-10 S42.02 is a billable code used to indicate a diagnosis of fracture of shaft of clavicle.

Key Diagnostic Point:

A fracture of the shaft of the clavicle is a common injury that typically occurs due to direct trauma or falls. The clavicle, or collarbone, connects the arm to the body and plays a crucial role in shoulder stability and function. Fractures can be classified as displaced or non-displaced, with displaced fractures often requiring surgical intervention. Symptoms include pain, swelling, and limited range of motion in the shoulder. Diagnosis is primarily through physical examination and imaging studies such as X-rays. Treatment may involve conservative management with a sling or surgical repair, depending on the fracture's severity and displacement. Complications can include nonunion or malunion of the fracture, which may necessitate further surgical intervention. Understanding the nuances of this injury is essential for accurate coding and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and non-displaced fractures
  • Understanding associated injuries such as shoulder dislocations or rotator cuff tears
  • Variability in treatment approaches (surgical vs. conservative)
  • Documentation of imaging studies and clinical findings

Audit Risk Factors

  • Inadequate documentation of fracture type (displaced vs. non-displaced)
  • Failure to document associated injuries
  • Incorrect coding of surgical procedures related to the fracture
  • Lack of follow-up documentation for complications

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and post-operative follow-ups are essential.

Common Clinical Scenarios

Surgical repair of displaced clavicle fractures, management of complications such as nonunion.

Billing Considerations

Ensure accurate documentation of surgical techniques and materials used.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation progress.

Common Clinical Scenarios

Rehabilitation following surgical repair or conservative management of clavicle fractures.

Billing Considerations

Documenting the patient's response to therapy and any modifications in treatment plans.

Coding Guidelines

Inclusion Criteria

Use S42.02 When
  • According to ICD
  • 10 guidelines, S42
  • 02 should be used for fractures of the shaft of the clavicle
  • It is important to document the type of fracture and any associated injuries

Exclusion Criteria

Do NOT use S42.02 When
  • Exclusion criteria include fractures of the acromial or sternal ends of the clavicle

Related ICD-10 Codes

Related CPT Codes

23630CPT Code

Open treatment of clavicular fracture

Clinical Scenario

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

Documentation Requirements

Operative report detailing the procedure and any implants used.

Specialty Considerations

Orthopedic surgeons must document the surgical approach and any complications.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of clavicle fractures, improving the accuracy of data collection and reimbursement processes. S42.02 provides a clear distinction between fracture types, aiding in clinical decision-making.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of clavicle fractures, improving the accuracy of data collection and reimbursement processes. S42.02 provides a clear distinction between fracture types, aiding in clinical decision-making.

Reimbursement & Billing Impact

reimbursement processes. S42.02 provides a clear distinction between fracture types, aiding in clinical decision-making.

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 S42.02 and S42.01?

S42.02 refers specifically to fractures of the shaft of the clavicle, while S42.01 pertains to fractures of the lateral end of the clavicle. Accurate coding depends on the specific location of the fracture.