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ICD-10 Guide
ICD-10 CodesS42.10

S42.10

Billable

Fracture of unspecified part of scapula

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

Code Description

ICD-10 S42.10 is a billable code used to indicate a diagnosis of fracture of unspecified part of scapula.

Key Diagnostic Point:

A fracture of the scapula, or shoulder blade, can occur due to trauma, falls, or direct blows to the shoulder area. The scapula is a flat bone that connects the humerus (upper arm bone) to the clavicle (collarbone) and plays a crucial role in shoulder mobility and stability. Fractures of the scapula are relatively rare compared to other fractures, often occurring in conjunction with other injuries, such as humeral fractures or shoulder dislocations. Symptoms typically include localized pain, swelling, and limited range of motion in the shoulder. Diagnosis is usually confirmed through imaging studies, such as X-rays or CT scans, which help to determine the extent and specific location of the fracture. Treatment may vary based on the severity of the fracture and can range from conservative management with rest and physical therapy to surgical intervention for more complex cases. Surgical options may include fixation with plates or screws to stabilize the fracture and restore function. Understanding the nuances of scapular fractures is essential for accurate coding and appropriate management of associated injuries.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

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

Audit Risk Factors

  • Inadequate documentation of fracture specifics
  • Failure to document associated injuries
  • Misclassification of fracture type
  • Lack of imaging reports in the medical record

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 falls, sports injuries, or motor vehicle accidents.

Billing Considerations

Documentation must clearly indicate the fracture type and any surgical interventions 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 progress and functional outcomes to support ongoing treatment.

Coding Guidelines

Inclusion Criteria

Use S42.10 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture's location, type, and any associated injuries
  • Include imaging findings and treatment plans in the medical record

Exclusion Criteria

Do NOT use S42.10 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, surgical

Clinical Scenario

Used in conjunction with S42.10 for surgical repair of associated injuries.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgery and any complications.

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.

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.

Reimbursement & Billing Impact

reimbursement processes.

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 significance of coding S42.10?

Coding S42.10 accurately reflects the patient's condition and ensures appropriate treatment and reimbursement. It is essential for tracking outcomes and managing care effectively.