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ICD-10 Guide
ICD-10 CodesS42.111

S42.111

Billable

Displaced fracture of body of scapula, right shoulder

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

Code Description

ICD-10 S42.111 is a billable code used to indicate a diagnosis of displaced fracture of body of scapula, right shoulder.

Key Diagnostic Point:

A displaced fracture of the body of the scapula is a serious injury that typically occurs due to high-energy trauma, such as a fall from a height or a motor vehicle accident. The scapula, or shoulder blade, plays a crucial role in shoulder stability and function, and a fracture in this area can significantly impair mobility and strength. Patients may present with severe pain, swelling, and limited range of motion in the shoulder. Diagnosis is often confirmed through imaging studies, such as X-rays or CT scans, which reveal the fracture's location and displacement. Treatment may involve conservative management with immobilization or surgical intervention, particularly if the fracture is significantly displaced or associated with other injuries. Surgical options may include open reduction and internal fixation (ORIF) to restore anatomical alignment and stability. Rehabilitation is essential for recovery, focusing on restoring range of motion, strength, and function.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of fracture types and their implications for treatment.
  • Differentiation from non-displaced fractures and other shoulder injuries.
  • Potential for associated injuries to the shoulder girdle.
  • Need for precise documentation of displacement and treatment approach.

Audit Risk Factors

  • Inadequate documentation of fracture type and displacement.
  • Failure to document associated injuries or complications.
  • Incorrect coding of surgical procedures related to the fracture.
  • Lack of clarity in treatment plans and follow-up care.

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Fractures resulting from sports injuries, falls, or accidents requiring surgical intervention.

Billing Considerations

Documentation must clearly outline the nature of the fracture, surgical approach, and any complications.

Physical Therapy

Documentation Requirements

Initial evaluation notes, progress reports, and discharge summaries.

Common Clinical Scenarios

Rehabilitation following surgical repair of scapular fractures.

Billing Considerations

Focus on functional outcomes and range of motion assessments.

Coding Guidelines

Inclusion Criteria

Use S42.111 When
  • Follow official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture's location, type, and treatment
  • Include any associated injuries or complications in the coding process

Exclusion Criteria

Do NOT use S42.111 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23630CPT Code

Open treatment of scapular fracture

Clinical Scenario

Used when surgical intervention is required for displaced fractures.

Documentation Requirements

Operative report detailing the procedure, indications, and post-operative care.

Specialty Considerations

Orthopedic surgeons must document the surgical approach 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 fractures, including the distinction between displaced and non-displaced fractures, which enhances the accuracy of patient records and billing.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including the distinction between displaced and non-displaced fractures, which enhances the accuracy of patient records and billing.

Reimbursement & Billing Impact

billing.

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 non-displaced fracture?

A displaced fracture means that the bone fragments are not aligned properly, while a non-displaced fracture means the bone remains in its normal position despite the fracture.