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ICD-10 Guide
ICD-10 CodesS42.114

S42.114

Billable

Nondisplaced fracture of body of scapula, right shoulder

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

Code Description

ICD-10 S42.114 is a billable code used to indicate a diagnosis of nondisplaced fracture of body of scapula, right shoulder.

Key Diagnostic Point:

A nondisplaced fracture of the body of the scapula is characterized by a break in the bone that does not result in a change in the alignment of the bone fragments. This type of fracture typically occurs due to high-impact trauma, such as falls or motor vehicle accidents, and can be associated with other shoulder injuries, including dislocations and rotator cuff tears. Patients may present with shoulder pain, swelling, and limited range of motion. Diagnosis is usually confirmed through imaging studies, such as X-rays or CT scans, which help to visualize the fracture and rule out associated injuries. Treatment often involves conservative management, including rest, ice, and physical therapy, although surgical intervention may be necessary in cases where there is significant instability or associated injuries. Understanding the nuances of this fracture is crucial for accurate coding and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Identifying associated injuries (e.g., rotator cuff tears)
  • Understanding the anatomical location of the fracture
  • Variability in treatment approaches (conservative vs. surgical)

Audit Risk Factors

  • Inadequate documentation of the fracture type
  • Failure to document associated injuries
  • Misclassification of fracture displacement
  • Lack of imaging report inclusion

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Fractures resulting from falls, sports injuries, or trauma requiring surgical intervention.

Billing Considerations

Ensure that all associated injuries are documented to support coding for potential surgical repairs.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation plans.

Common Clinical Scenarios

Patients undergoing rehabilitation post-fracture for strength and mobility.

Billing Considerations

Documenting progress and response to therapy is crucial for accurate coding.

Coding Guidelines

Inclusion Criteria

Use S42.114 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the fracture is documented as nondisplaced and specifying the right shoulder
  • Include any associated conditions or injuries for comprehensive coding

Exclusion Criteria

Do NOT use S42.114 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, diagnostic

Clinical Scenario

Used when assessing for associated injuries in the shoulder.

Documentation Requirements

Document the reason for the procedure and findings.

Specialty Considerations

Orthopedic surgeons should ensure clarity in operative notes.

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 diagnoses and treatment plans. S42.114 provides a clear distinction between nondisplaced and displaced fractures, which is crucial for appropriate management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of diagnoses and treatment plans. S42.114 provides a clear distinction between nondisplaced and displaced fractures, which is crucial for appropriate management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of diagnoses and treatment plans. S42.114 provides a clear distinction between nondisplaced and displaced fractures, which is crucial for appropriate 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 a displaced and nondisplaced fracture?

A displaced fracture involves a break in the bone where the ends are not aligned, while a nondisplaced fracture means the bone cracks but maintains its proper alignment.