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ICD-10 Guide
ICD-10 CodesS42.153

S42.153

Billable

Displaced fracture of neck of scapula, unspecified shoulder

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

Code Description

ICD-10 S42.153 is a billable code used to indicate a diagnosis of displaced fracture of neck of scapula, unspecified shoulder.

Key Diagnostic Point:

A displaced fracture of the neck of the scapula is a serious injury that typically occurs due to high-impact trauma, such as falls or vehicular accidents. The scapula, or shoulder blade, plays a crucial role in shoulder stability and mobility. A fracture in this area can lead to significant pain, limited range of motion, and potential complications such as nerve damage or rotator cuff injuries. Patients may present with shoulder pain, swelling, and difficulty moving the arm. Diagnosis is usually confirmed through imaging studies, such as X-rays or CT scans, which reveal the fracture's location and displacement. Treatment often involves immobilization, pain management, and in some cases, surgical intervention to realign the bone fragments. Rehabilitation is essential for restoring function and strength to the shoulder joint post-injury. The complexity of managing such fractures lies in the potential for associated injuries, including dislocations or humeral fractures, which may require comprehensive orthopedic evaluation and intervention.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture displacement and associated injuries
  • Need for precise imaging documentation
  • Potential for surgical intervention and post-operative coding
  • Differentiation from similar shoulder injuries

Audit Risk Factors

  • Inadequate documentation of fracture type and displacement
  • Failure to document associated injuries or complications
  • Lack of clarity in imaging reports
  • Improper linkage of diagnosis to surgical procedures

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 falls, sports injuries, or accidents requiring surgical repair.

Billing Considerations

Ensure documentation reflects the complexity of the fracture and any associated procedures performed.

Physical Therapy

Documentation Requirements

Progress notes detailing patient rehabilitation, range of motion assessments, and functional outcomes.

Common Clinical Scenarios

Rehabilitation following surgical repair of scapular fractures or conservative management of non-displaced fractures.

Billing Considerations

Document specific therapeutic interventions and patient responses to treatment.

Coding Guidelines

Inclusion Criteria

Use S42.153 When
  • Follow official ICD
  • CM guidelines for coding fractures, including specificity regarding the location and type of fracture
  • Ensure compliance with guidelines for coding associated injuries and complications

Exclusion Criteria

Do NOT use S42.153 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, surgical

Clinical Scenario

Used in cases where surgical intervention is required for displaced fractures.

Documentation Requirements

Operative reports detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgery 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 shoulder injuries, including displaced fractures of the scapula. This specificity 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 shoulder injuries, including displaced fractures of the scapula. This specificity 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 shoulder injuries, including displaced fractures of the scapula. This specificity 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 non-displaced fracture of the scapula?

A displaced fracture involves a separation of the bone fragments, which can lead to instability and requires more intensive treatment, while a non-displaced fracture means the bone remains aligned.