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ICD-10 Guide
ICD-10 CodesS42.126

S42.126

Billable

Nondisplaced fracture of acromial process, unspecified shoulder

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

Code Description

ICD-10 S42.126 is a billable code used to indicate a diagnosis of nondisplaced fracture of acromial process, unspecified shoulder.

Key Diagnostic Point:

A nondisplaced fracture of the acromial process is a type of shoulder injury where the acromion, a bony projection on the scapula (shoulder blade), experiences a fracture without any displacement of the bone fragments. This condition typically arises from trauma, such as a fall onto the shoulder or direct impact during sports activities. Patients may present with localized pain, swelling, and limited range of motion in the shoulder. Diagnosis is often confirmed through imaging studies, such as X-rays or MRI, which can help differentiate this injury from other shoulder conditions like dislocations or rotator cuff tears. Treatment usually involves conservative management, including rest, ice, and physical therapy, although surgical intervention may be necessary in cases of persistent symptoms or associated injuries. Understanding the nuances of this fracture is crucial for accurate coding and appropriate management, as it can impact the patient's recovery and rehabilitation process.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from other shoulder injuries such as dislocations and rotator cuff tears.
  • Need for precise documentation of the fracture type and location.
  • Variability in treatment approaches based on associated injuries.
  • Potential for misclassification with similar codes.

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury.
  • Failure to specify the location of the fracture.
  • Misinterpretation of imaging results.
  • Inconsistent treatment documentation.

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes and imaging reports are essential for accurate coding.

Common Clinical Scenarios

Fractures resulting from falls, sports injuries, or accidents.

Billing Considerations

Documentation must clearly indicate the nondisplaced nature of the fracture and any associated injuries.

Physical Therapy

Documentation Requirements

Progress notes detailing the patient's rehabilitation progress and response to treatment.

Common Clinical Scenarios

Patients undergoing rehabilitation post-fracture for range of motion and strength.

Billing Considerations

Therapists should document functional limitations and improvements to support ongoing treatment.

Coding Guidelines

Inclusion Criteria

Use S42.126 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the fracture is documented as nondisplaced and specifying the acromial process

Exclusion Criteria

Do NOT use S42.126 When
  • Exclude codes for displaced fractures or other shoulder injuries unless they are also present

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, diagnostic

Clinical Scenario

Used when assessing shoulder injuries including fractures.

Documentation Requirements

Document the findings and any interventions performed.

Specialty Considerations

Orthopedic surgeons should ensure detailed operative notes are provided.

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 diagnoses and treatment plans. S42.126 provides a clear distinction for nondisplaced fractures, which aids in appropriate management and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of shoulder injuries, improving the accuracy of diagnoses and treatment plans. S42.126 provides a clear distinction for nondisplaced fractures, which aids in appropriate management and reimbursement.

Reimbursement & Billing Impact

reimbursement.

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 separation of the bone fragments, while a nondisplaced fracture means the bone cracks but maintains its proper alignment.