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ICD-10 Guide
ICD-10 CodesS42.101

S42.101

Billable

Fracture of unspecified part of scapula, right shoulder

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

Code Description

ICD-10 S42.101 is a billable code used to indicate a diagnosis of fracture of unspecified part of scapula, right shoulder.

Key Diagnostic Point:

A fracture of the scapula, particularly in the right shoulder, can occur due to trauma, such as falls or direct blows. The scapula, or shoulder blade, is a flat bone that connects the humerus (upper arm bone) to the clavicle (collarbone). Fractures in this area can be classified as either displaced or non-displaced, and they may involve various parts of the scapula, including the body, glenoid, or acromion. Symptoms typically include localized pain, swelling, and limited range of motion in the shoulder. Diagnosis is often confirmed through imaging studies such as X-rays or CT scans. Treatment may vary based on the severity of the fracture and can range from conservative management with immobilization to surgical intervention for more complex cases. Understanding the specific nature of the fracture is crucial for appropriate management and rehabilitation, as it can significantly impact the patient's recovery and functional outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and locations within the scapula
  • Need for precise documentation of fracture details
  • Potential for associated injuries to the shoulder joint or surrounding structures
  • Differentiation from other shoulder injuries such as dislocations or rotator cuff tears

Audit Risk Factors

  • Inadequate documentation of the fracture type and location
  • Failure to specify whether the fracture is displaced or non-displaced
  • Misclassification of associated injuries
  • Inconsistent coding practices among providers

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging results, and follow-up notes are essential for accurate coding.

Common Clinical Scenarios

Fractures requiring surgical fixation, management of complications, or rehabilitation protocols.

Billing Considerations

Documentation must clearly outline the fracture type, treatment plan, and any associated injuries.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation progress.

Common Clinical Scenarios

Patients undergoing rehabilitation post-fracture or surgical repair.

Billing Considerations

Focus on functional outcomes and the impact of the fracture on daily activities.

Coding Guidelines

Inclusion Criteria

Use S42.101 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the fracture is documented accurately, including the mechanism of injury and any associated conditions

Exclusion Criteria

Do NOT use S42.101 When
  • Exclude codes for fractures that are clearly defined in other categories

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, diagnostic

Clinical Scenario

Used when assessing shoulder injuries, including fractures.

Documentation Requirements

Operative report detailing findings and procedures performed.

Specialty Considerations

Orthopedic surgeons should document the rationale for arthroscopy.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of shoulder injuries, 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 shoulder injuries, 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 difference between S42.101 and S42.100?

S42.101 specifies a fracture of the right scapula, while S42.100 is used for unspecified fractures of the scapula, regardless of side.