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ICD-10 Guide
ICD-10 CodesS42.121

S42.121

Billable

Displaced fracture of acromial process, right shoulder

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

Code Description

ICD-10 S42.121 is a billable code used to indicate a diagnosis of displaced fracture of acromial process, right shoulder.

Key Diagnostic Point:

A displaced fracture of the acromial process of the scapula occurs when there is a break in the bone that is not aligned properly, typically due to trauma or injury. The acromial process is the bony prominence on the top of the shoulder blade, which connects to the collarbone and forms part of the shoulder joint. This type of fracture can result from falls, direct blows to the shoulder, or accidents involving the upper extremities. Symptoms often include severe pain, swelling, bruising, and limited range of motion in the shoulder. Diagnosis is typically confirmed through imaging studies such as X-rays or CT scans, which reveal the extent of the fracture and any displacement. Treatment may involve conservative management with rest, ice, and immobilization, or surgical intervention if the fracture is significantly displaced or if there are associated injuries to the rotator cuff or other structures. Rehabilitation is crucial for restoring function and strength to the shoulder post-injury.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and non-displaced fractures
  • Identifying associated injuries to the rotator cuff or other shoulder structures
  • Understanding the implications of surgical versus non-surgical treatment
  • Navigating documentation requirements for trauma cases

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the degree of displacement
  • Misclassification of fracture type
  • Lack of follow-up documentation post-treatment

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and post-operative notes are essential for accurate coding.

Common Clinical Scenarios

Fractures resulting from sports injuries, falls, or vehicular accidents.

Billing Considerations

Ensure that all associated injuries are documented to support the complexity of the case.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation progress notes.

Common Clinical Scenarios

Patients undergoing rehabilitation after surgical repair of shoulder fractures.

Billing Considerations

Documenting the patient's response to therapy and any complications that arise during rehabilitation.

Coding Guidelines

Inclusion Criteria

Use S42.121 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture type, location, and any associated injuries
  • Include details about the mechanism of injury and treatment plan

Exclusion Criteria

Do NOT use S42.121 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopic repair of rotator cuff

Clinical Scenario

Used in cases where the fracture is associated with a rotator cuff tear.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should document the extent of the injury and any repairs performed.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of shoulder injuries, improving the accuracy of claims and facilitating better patient management.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of shoulder injuries, improving the accuracy of claims and facilitating better patient management.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of shoulder injuries, improving the accuracy of claims and facilitating better patient 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 non-displaced fracture?

A displaced fracture means that the bone has broken and moved out of alignment, while a non-displaced fracture means the bone is cracked but remains in its normal position.