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ICD-10 Guide
ICD-10 CodesS42.026

S42.026

Billable

Nondisplaced fracture of shaft of unspecified clavicle

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

Code Description

ICD-10 S42.026 is a billable code used to indicate a diagnosis of nondisplaced fracture of shaft of unspecified clavicle.

Key Diagnostic Point:

A nondisplaced fracture of the shaft of the clavicle occurs when the bone is broken but the fragments remain in alignment. This type of fracture is common in individuals who experience falls or direct trauma to the shoulder area. Symptoms typically include pain at the site of the fracture, swelling, and limited range of motion in the shoulder. Diagnosis is usually confirmed through physical examination and imaging studies such as X-rays. Treatment often involves conservative management, including rest, immobilization with a sling, and pain management. Surgical intervention may be required in cases where the fracture is associated with significant displacement or complications. Understanding the nuances of this fracture is crucial for accurate coding, as it can impact treatment plans and reimbursement. Proper documentation is essential to reflect the nature of the injury and the treatment provided, ensuring that the coding accurately represents the clinical scenario.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Identifying the specific location of the fracture
  • Understanding associated injuries (e.g., rotator cuff injuries)
  • Documenting the mechanism of injury accurately

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the location of the fracture
  • Misclassification of fracture type (displaced vs. nondisplaced)
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and follow-up notes are essential.

Common Clinical Scenarios

Fractures resulting from sports injuries, falls, or accidents.

Billing Considerations

Documentation must clearly indicate the type of fracture and any associated injuries.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation plans.

Common Clinical Scenarios

Patients undergoing rehabilitation post-fracture.

Billing Considerations

Focus on recovery goals and progress notes to support coding.

Coding Guidelines

Inclusion Criteria

Use S42.026 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the fracture is documented as nondisplaced and specifying the location
  • Include any relevant external cause codes if applicable

Exclusion Criteria

Do NOT use S42.026 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 nondisplaced fracture that requires stabilization.

Documentation Requirements

Operative report detailing the procedure and indications for surgery.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgical intervention.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of clinical data and reimbursement processes. S42.026 provides clarity in documenting nondisplaced fractures, which can influence treatment decisions and outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of clinical data and reimbursement processes. S42.026 provides clarity in documenting nondisplaced fractures, which can influence treatment decisions and outcomes.

Reimbursement & Billing Impact

reimbursement processes. S42.026 provides clarity in documenting nondisplaced fractures, which can influence treatment decisions and 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 difference between a displaced and nondisplaced fracture?

A displaced fracture involves a break in the bone where the ends are not aligned, while a nondisplaced fracture means the bone remains in its normal position despite being broken.