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ICD-10 Guide
ICD-10 CodesS42.192

S42.192

Billable

Fracture of other part of scapula, left shoulder

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

Code Description

ICD-10 S42.192 is a billable code used to indicate a diagnosis of fracture of other part of scapula, left shoulder.

Key Diagnostic Point:

The S42.192 code refers to a fracture of the scapula, specifically indicating that the fracture occurs in a part of the scapula that is not classified under the more common fracture sites such as the body or the glenoid. Scapular fractures are relatively rare and often occur due to high-energy trauma, such as motor vehicle accidents or falls from significant heights. The left shoulder's anatomy includes the scapula, which plays a crucial role in shoulder stability and function. Fractures in this area can lead to complications such as shoulder dislocations, humeral head fractures, and rotator cuff injuries. Patients may present with pain, swelling, and limited range of motion. Diagnosis typically involves physical examination and imaging studies, such as X-rays or CT scans, to assess the fracture's location and severity. Treatment may vary from conservative management, including immobilization and physical therapy, to surgical intervention, such as open reduction and internal fixation, depending on the fracture's complexity and associated injuries.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture location and type
  • Potential for associated injuries (e.g., dislocations, 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 document 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 reports, imaging studies, and post-operative notes are essential for accurate coding.

Common Clinical Scenarios

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

Billing Considerations

Documentation must clearly indicate the fracture type, location, and any associated procedures performed.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation plans.

Common Clinical Scenarios

Patients recovering from scapular fractures requiring physical therapy.

Billing Considerations

Focus on documenting the impact of the fracture on mobility and function.

Coding Guidelines

Inclusion Criteria

Use S42.192 When
  • According to ICD
  • 10 coding guidelines, S42
  • 192 should be used when a fracture of the scapula is confirmed, and it is essential to document the specific part of the scapula affected

Exclusion Criteria

Do NOT use S42.192 When
  • Exclusion criteria include fractures that are classified under other specific codes for scapular fractures

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, surgical

Clinical Scenario

Used in cases where surgical intervention is needed for scapular fractures.

Documentation Requirements

Operative reports detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must ensure that the procedure aligns with the diagnosis.

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 data collection and reimbursement processes. S42.192 provides a clear distinction for fractures that may not fit into more common categories.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of scapular fractures, improving the accuracy of data collection and reimbursement processes. S42.192 provides a clear distinction for fractures that may not fit into more common categories.

Reimbursement & Billing Impact

reimbursement processes. S42.192 provides a clear distinction for fractures that may not fit into more common categories.

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 left scapular fracture?

Treatment typically involves conservative management with rest and physical therapy, but surgical intervention may be necessary for displaced fractures or those with associated injuries.