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ICD-10 Guide
ICD-10 CodesS42.124

S42.124

Billable

Nondisplaced fracture of acromial process, right shoulder

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

Code Description

ICD-10 S42.124 is a billable code used to indicate a diagnosis of nondisplaced fracture of acromial process, right shoulder.

Key Diagnostic Point:

A nondisplaced fracture of the acromial process 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 a fall onto the shoulder or direct trauma to the area. The acromial process is a bony projection on the scapula that forms the highest point of the shoulder and serves as an attachment site for ligaments and muscles. Patients may present with localized pain, swelling, and limited range of motion in the shoulder. Diagnosis is often confirmed through imaging studies such as X-rays or CT scans. Treatment usually involves conservative management, including rest, ice, and physical therapy, although surgical intervention may be necessary in cases of associated injuries or if conservative measures fail. Understanding the implications of this fracture is crucial for effective rehabilitation and return to normal function.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Understanding associated injuries to the shoulder complex
  • Documentation of imaging studies and clinical findings
  • Variability in treatment approaches based on patient age and activity level

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify laterality (right vs. left)
  • Misclassification of fracture type (displaced vs. nondisplaced)
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes if surgery is performed, including type of fracture, fixation method, and postoperative care.

Common Clinical Scenarios

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

Billing Considerations

Ensure accurate coding of any associated procedures, such as rotator cuff repairs or shoulder arthroscopy.

Physical Therapy

Documentation Requirements

Progress notes detailing patient response to therapy, range of motion assessments, and functional outcomes.

Common Clinical Scenarios

Rehabilitation following a nondisplaced fracture, focusing on restoring strength and mobility.

Billing Considerations

Document any modifications in therapy based on patient progress and pain levels.

Coding Guidelines

Inclusion Criteria

Use S42.124 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture type, laterality, and any associated injuries
  • Include details from imaging studies and clinical assessments to support the diagnosis

Exclusion Criteria

Do NOT use S42.124 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 during surgery.

Documentation Requirements

Operative report detailing findings and any interventions performed.

Specialty Considerations

Orthopedic surgeons should ensure accurate coding of any additional procedures performed.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, including laterality and displacement status, which aids in better tracking of treatment outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including laterality and displacement status, which aids in better tracking of treatment outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fractures, including laterality and displacement status, which aids in better tracking of treatment outcomes and resource allocation.

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 fragments are misaligned, while a nondisplaced fracture means the bone cracks but maintains its proper alignment.