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ICD-10 Guide
ICD-10 CodesS42.19

S42.19

Billable

Fracture of other part of scapula

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

Code Description

ICD-10 S42.19 is a billable code used to indicate a diagnosis of fracture of other part of scapula.

Key Diagnostic Point:

The S42.19 code is used to classify fractures of the scapula that do not fall into the more commonly specified categories, such as fractures of the scapular body or glenoid. These fractures can occur due to trauma, such as falls or direct blows to the shoulder, and may involve various parts of the scapula, including the acromion, coracoid process, or scapular spine. Clinical presentation often includes shoulder pain, swelling, and limited range of motion. Diagnosis typically involves imaging studies like X-rays or CT scans to confirm the fracture type and assess for associated injuries. Treatment may vary from conservative management, such as immobilization and physical therapy, to surgical intervention in cases of significant displacement or instability. Understanding the nuances of this code is essential for accurate billing and ensuring appropriate care is documented, especially in the context of related shoulder injuries, such as dislocations or rotator cuff tears, which may complicate the clinical picture.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture location and type within the scapula.
  • Potential for associated injuries to the shoulder joint or surrounding structures.
  • Need for precise documentation of the fracture type and treatment approach.
  • Differentiation from other shoulder injuries, such as dislocations or humeral fractures.

Audit Risk Factors

  • Inadequate documentation of fracture specifics.
  • Failure to document associated injuries.
  • Incorrect coding of fracture type leading to claim denials.
  • Lack of clarity in treatment plans and follow-up care.

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging results, and post-operative care notes.

Common Clinical Scenarios

Fractures requiring surgical fixation, management of complex shoulder injuries.

Billing Considerations

Ensure accurate coding of surgical procedures performed in conjunction with fracture repair.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation plans.

Common Clinical Scenarios

Rehabilitation following surgical repair of scapular fractures.

Billing Considerations

Documenting progress and functional outcomes is crucial for coding therapy services.

Coding Guidelines

Inclusion Criteria

Use S42.19 When
  • According to ICD
  • 10 coding guidelines, S42
  • 19 should be used when the specific part of the scapula is not otherwise classified
  • Coders must ensure that the documentation supports the diagnosis and that any associated injuries are also coded appropriately

Exclusion Criteria

Do NOT use S42.19 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, surgical

Clinical Scenario

Used in conjunction with S42.19 when surgical intervention is required for fracture repair.

Documentation Requirements

Operative report 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 scapular fractures, improving the accuracy of claims and facilitating better patient management through detailed documentation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of scapular fractures, improving the accuracy of claims and facilitating better patient management through detailed documentation.

Reimbursement & Billing Impact

reimbursement.

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 primary treatment for a fracture of the scapula?

Treatment typically involves conservative management with immobilization, physical therapy, and in some cases, surgical intervention if the fracture is displaced or unstable.