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ICD-10 Guide
ICD-10 CodesS42.191

S42.191

Billable

Fracture of other part of scapula, right shoulder

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

Code Description

ICD-10 S42.191 is a billable code used to indicate a diagnosis of fracture of other part of scapula, right shoulder.

Key Diagnostic Point:

The S42.191 code refers to a fracture of the scapula, specifically in areas other than the glenoid or acromion. Scapular fractures are relatively uncommon and often occur due to high-energy trauma, such as motor vehicle accidents or falls from significant heights. Patients may present with shoulder pain, swelling, and limited range of motion. Diagnosis typically involves physical examination and imaging studies, such as X-rays or CT scans, to confirm the fracture and assess for associated injuries. Treatment may vary based on the fracture's location and severity, ranging from conservative management with immobilization to surgical intervention for displaced fractures. Surgical options may include open reduction and internal fixation (ORIF) to restore the anatomical alignment of the scapula. Rehabilitation is crucial for restoring function and strength in the shoulder joint post-injury. Understanding the nuances of scapular fractures is essential for accurate coding and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture location and type
  • Potential for associated injuries (e.g., humeral fractures, rotator cuff tears)
  • Need for precise documentation of fracture details
  • Differentiation from other shoulder injuries

Audit Risk Factors

  • Inadequate documentation of fracture specifics
  • Failure to report associated injuries
  • Incorrect coding of fracture type or location
  • Lack of clarity in treatment plans

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

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

Billing Considerations

Documentation must clearly indicate the fracture type, treatment plan, and any complications.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation progress.

Common Clinical Scenarios

Patients undergoing rehabilitation post-surgery for scapular fractures.

Billing Considerations

Focus on functional outcomes and the impact of the injury on daily activities.

Coding Guidelines

Inclusion Criteria

Use S42.191 When
  • Follow official ICD
  • CM guidelines for coding fractures, including the need for specificity regarding the fracture site and type
  • Ensure that documentation supports the diagnosis and treatment plan

Exclusion Criteria

Do NOT use S42.191 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23630CPT Code

Open treatment of scapular fracture

Clinical Scenario

Used when surgical intervention is required for a scapular fracture.

Documentation Requirements

Operative report detailing the procedure, indications, and post-operative care.

Specialty Considerations

Orthopedic surgeons must ensure accurate coding based on the specific fracture type.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding scapular fractures, improving the accuracy of patient records and treatment plans.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding scapular fractures, improving the accuracy of patient records and treatment plans.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding scapular fractures, improving the accuracy of patient records and treatment plans.

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 are the common causes of scapular fractures?

Scapular fractures are typically caused by high-energy trauma, such as motor vehicle accidents, falls from heights, or sports injuries.

How is a scapular fracture diagnosed?

Diagnosis is made through a combination of physical examination and imaging studies, including X-rays and CT scans.

What are the treatment options for scapular fractures?

Treatment may include conservative management with immobilization or surgical intervention, such as open reduction and internal fixation, depending on the fracture's severity.