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ICD-10 Guide
ICD-10 CodesS42.01

S42.01

Billable

Fracture of sternal end of clavicle

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

Code Description

ICD-10 S42.01 is a billable code used to indicate a diagnosis of fracture of sternal end of clavicle.

Key Diagnostic Point:

A fracture of the sternal end of the clavicle is a specific type of injury that occurs at the junction where the clavicle meets the sternum. This injury is often the result of direct trauma, such as a fall or a collision, and can be associated with other shoulder injuries, including dislocations and fractures of the humerus. Clinically, patients may present with pain, swelling, and limited range of motion in the shoulder area. Physical examination may reveal tenderness over the sternal end of the clavicle, and imaging studies such as X-rays or CT scans are typically employed to confirm the diagnosis and assess the extent of the fracture. Treatment options vary based on the severity of the fracture and may include conservative management with immobilization or surgical intervention in cases of significant displacement. Understanding the implications of this fracture is crucial, as it can affect shoulder stability and function, potentially leading to complications such as rotator cuff injuries or chronic pain if not properly managed.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of the fracture
  • Potential for associated injuries (e.g., shoulder dislocations, humeral fractures)
  • Need for precise documentation of imaging findings
  • Differentiation from other types of clavicular fractures

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to document associated injuries
  • Incorrect coding of fracture type or location
  • Lack of imaging reports to support the diagnosis

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging studies, and post-operative care documentation are essential.

Common Clinical Scenarios

Fractures resulting from sports injuries, falls, or vehicular accidents.

Billing Considerations

Documentation must clearly indicate the type of fracture and any associated injuries to ensure accurate coding.

Emergency Medicine

Documentation Requirements

Thorough documentation of initial assessment, imaging results, and treatment provided.

Common Clinical Scenarios

Patients presenting with acute shoulder pain following trauma.

Billing Considerations

Accurate coding requires clear documentation of the mechanism of injury and any immediate interventions performed.

Coding Guidelines

Inclusion Criteria

Use S42.01 When
  • According to ICD
  • 10 coding guidelines, S42
  • 01 should be used when the fracture is confirmed by imaging
  • It is important to document the specific type of fracture and any associated injuries

Exclusion Criteria

Do NOT use S42.01 When
  • Exclusion criteria include fractures that are not specifically at the sternal end of the clavicle

Related ICD-10 Codes

Related CPT Codes

23630CPT Code

Open treatment of clavicular fracture

Clinical Scenario

Used when surgical intervention is required for displaced fractures.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the specifics of the fracture and the surgical approach.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, including the sternal end of the clavicle, which enhances the accuracy of patient records and treatment plans.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including the sternal end of the clavicle, which enhances the accuracy of patient records and treatment plans.

Reimbursement & Billing Impact

reimbursement and to avoid denials.

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 imaging is required to confirm a fracture of the sternal end of the clavicle?

X-rays are typically the first-line imaging modality, but CT scans may be used for more complex cases to assess the extent of the fracture and any associated injuries.