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ICD-10 Guide
ICD-10 CodesS42.115

S42.115

Billable

Nondisplaced fracture of body of scapula, left shoulder

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

Code Description

ICD-10 S42.115 is a billable code used to indicate a diagnosis of nondisplaced fracture of body of scapula, left shoulder.

Key Diagnostic Point:

A nondisplaced fracture of the body of the scapula occurs when there is a break in the bone without any significant displacement of the fracture fragments. This type of fracture is often the result of direct trauma, such as a fall or a high-impact collision, and can be associated with shoulder dislocations or other injuries to the shoulder girdle. Patients may present with localized pain, swelling, and limited range of motion in the shoulder. Diagnosis typically involves physical examination and imaging studies, such as X-rays or CT scans, to confirm the fracture and rule out associated injuries. Treatment may include conservative management with rest, ice, and immobilization, or surgical intervention if there are complications or if the fracture is associated with other injuries. Rehabilitation is crucial for restoring function and strength to the shoulder post-injury.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Understanding associated injuries such as dislocations or rotator cuff tears
  • Documentation of imaging studies and clinical findings
  • Variability in treatment approaches based on patient age and activity level

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to document associated injuries
  • Incorrect coding of fracture type (displaced vs. nondisplaced)
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging reports, and follow-up assessments.

Common Clinical Scenarios

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

Billing Considerations

Ensure clear documentation of fracture type and any surgical interventions performed.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessment of functional limitations and rehabilitation progress.

Common Clinical Scenarios

Patients undergoing rehabilitation post-fracture for strength and mobility.

Billing Considerations

Document the patient's progress and any modifications to the rehabilitation plan.

Coding Guidelines

Inclusion Criteria

Use S42.115 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture type and any associated injuries
  • Include details on the mechanism of injury and treatment plan

Exclusion Criteria

Do NOT use S42.115 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, diagnostic, with or without synovial biopsy

Clinical Scenario

Used in cases where a nondisplaced fracture is suspected to be associated with rotator cuff injury.

Documentation Requirements

Document indications for arthroscopy and findings during the procedure.

Specialty Considerations

Orthopedic surgeons should ensure clear documentation of the fracture and any concurrent procedures.

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 data collection and reimbursement processes. S42.115 provides a clear distinction between nondisplaced and displaced fractures, which is crucial for treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of data collection and reimbursement processes. S42.115 provides a clear distinction between nondisplaced and displaced fractures, which is crucial for treatment planning.

Reimbursement & Billing Impact

reimbursement processes. S42.115 provides a clear distinction between nondisplaced and displaced fractures, which is crucial for treatment planning.

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 where the bone fragments are misaligned, while a nondisplaced fracture means the bone cracks but maintains its proper alignment.