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v1.0.0
ICD-10 Guide
ICD-10 CodesS42.0

S42.0

Billable

Fracture of clavicle

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

Code Description

ICD-10 S42.0 is a billable code used to indicate a diagnosis of fracture of clavicle.

Key Diagnostic Point:

A fracture of the clavicle, commonly referred to as a collarbone fracture, typically occurs due to a fall onto the shoulder or an outstretched arm. This injury is prevalent in sports and can also result from direct trauma, such as a car accident. Clinically, patients may present with pain, swelling, and a visible deformity in the shoulder area. The fracture can be classified as either a mid-shaft fracture, which is the most common, or a distal or proximal fracture, depending on the location of the break. Diagnosis is usually confirmed through physical examination and imaging studies, such as X-rays. Treatment options vary based on the severity of the fracture and may include conservative management with a sling and physical therapy or surgical intervention for more complex cases. Surgical options often involve the use of plates, screws, or intramedullary rods to stabilize the fracture. Rehabilitation is crucial for restoring function and strength to the shoulder joint, especially in athletes and active individuals.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types (mid-shaft, distal, proximal)
  • Potential for associated injuries (e.g., shoulder dislocations, humeral fractures)
  • Different treatment approaches (conservative vs. surgical)
  • Need for precise documentation of fracture location and type

Audit Risk Factors

  • Inadequate documentation of fracture type and location
  • Failure to document associated injuries
  • Incorrect coding of treatment type (surgical vs. non-surgical)
  • Misinterpretation of imaging results

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Surgical repair of a displaced clavicle fracture, management of associated shoulder injuries.

Billing Considerations

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

Physical Therapy

Documentation Requirements

Progress notes, treatment plans, and functional assessments.

Common Clinical Scenarios

Rehabilitation following clavicle fracture repair, management of shoulder mobility and strength.

Billing Considerations

Document specific therapeutic interventions and patient progress to support billing.

Coding Guidelines

Inclusion Criteria

Use S42.0 When
  • Follow official coding guidelines for fractures, including the need for specificity in fracture location and type
  • Ensure compliance with documentation standards for surgical procedures if applicable

Exclusion Criteria

Do NOT use S42.0 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23630CPT Code

Open treatment of clavicular fracture

Clinical Scenario

Used when surgical intervention is performed for a displaced clavicle fracture.

Documentation Requirements

Operative report detailing the procedure and any implants used.

Specialty Considerations

Orthopedic surgeons must ensure accurate coding of the procedure performed.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding fractures, including clavicle fractures. This specificity aids in better tracking of injury patterns and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding fractures, including clavicle fractures. This specificity aids in better tracking of injury patterns and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding fractures, including clavicle fractures. This specificity aids in better tracking of injury patterns and treatment outcomes.

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 most common cause of a clavicle fracture?

The most common cause of a clavicle fracture is a fall onto the shoulder or an outstretched arm, often seen in sports injuries.