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ICD-10 Guide
ICD-10 CodesS42.123

S42.123

Billable

Displaced fracture of acromial process, unspecified shoulder

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

Code Description

ICD-10 S42.123 is a billable code used to indicate a diagnosis of displaced fracture of acromial process, unspecified shoulder.

Key Diagnostic Point:

A displaced fracture of the acromial process is a type of shoulder injury that occurs when the acromion, a bony projection on the scapula (shoulder blade), is fractured. This injury is often the result of trauma, such as a fall or direct impact to the shoulder. The acromion plays a crucial role in shoulder stability and function, serving as an attachment point for muscles and ligaments. Displacement indicates that the fracture fragments have moved from their normal anatomical position, which can lead to complications such as impingement, rotator cuff injuries, or chronic pain if not properly treated. Diagnosis typically involves physical examination and imaging studies, such as X-rays or MRI, to assess the extent of the fracture and any associated injuries. Treatment may include conservative management with rest, ice, and physical therapy, or surgical intervention to realign and stabilize the fracture, especially in cases of significant displacement. The prognosis is generally favorable with appropriate management, although recovery may vary based on the severity of the fracture and the patient's overall health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of fracture type and displacement
  • Need for precise imaging reports to confirm diagnosis
  • Potential for associated injuries (e.g., rotator cuff tears)
  • Differentiation from other shoulder injuries (e.g., dislocations)

Audit Risk Factors

  • Inadequate documentation of fracture details
  • Failure to document associated injuries or complications
  • Misinterpretation of imaging results
  • Inconsistent coding of treatment procedures

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and post-operative notes are essential for accurate coding.

Common Clinical Scenarios

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

Billing Considerations

Ensure clear documentation of fracture displacement and any associated procedures performed.

Physical Therapy

Documentation Requirements

Progress notes detailing rehabilitation protocols and patient response to treatment.

Common Clinical Scenarios

Patients recovering from surgical repair of acromial fractures or conservative management.

Billing Considerations

Document functional limitations and progress towards rehabilitation goals.

Coding Guidelines

Inclusion Criteria

Use S42.123 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture type, displacement, and any associated injuries
  • Include relevant clinical information to support the diagnosis

Exclusion Criteria

Do NOT use S42.123 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopic repair of rotator cuff

Clinical Scenario

Used in conjunction with S42.123 when a rotator cuff injury is present.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should ensure clear linkage between the fracture and any surgical repairs performed.

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, including displaced fractures, which enhances the accuracy of patient records and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of shoulder injuries, including displaced fractures, which enhances the accuracy of patient records 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 a displaced and non-displaced fracture?

A displaced fracture means that the bone fragments have moved out of alignment, while a non-displaced fracture means the bone remains in its normal position despite the fracture.