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ICD-10 Guide
ICD-10 CodesS42.136

S42.136

Billable

Nondisplaced fracture of coracoid process, unspecified shoulder

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

Code Description

ICD-10 S42.136 is a billable code used to indicate a diagnosis of nondisplaced fracture of coracoid process, unspecified shoulder.

Key Diagnostic Point:

A nondisplaced fracture of the coracoid process is a type of shoulder injury where the coracoid process, a small hook-like bony projection on the scapula, sustains a fracture without any displacement of the bone fragments. This injury is often associated with trauma, such as falls or direct blows to the shoulder, and can occur in conjunction with other shoulder injuries, including dislocations and rotator cuff tears. Patients may present with localized pain, swelling, and tenderness over the shoulder, particularly at the site of the coracoid process. Diagnosis typically involves physical examination and imaging studies, such as X-rays or MRI, to confirm the fracture and assess for any associated injuries. Treatment may include conservative management with rest, ice, and analgesics, or surgical intervention if there are complications or if the fracture is associated with significant instability. Understanding the implications of this fracture is crucial, as it can affect shoulder function and may require rehabilitation to restore full range of motion and strength.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Identifying associated injuries such as rotator cuff tears or dislocations
  • Understanding the anatomical location and implications of the coracoid process
  • 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
  • Misclassification of fracture type (displaced vs. nondisplaced)
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and follow-up 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 type and any surgical repairs performed.

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

Documenting the impact of the injury on daily activities and rehabilitation goals.

Coding Guidelines

Inclusion Criteria

Use S42.136 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 S42.136 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, surgical

Clinical Scenario

Used when surgical intervention is required for associated injuries.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the rationale for surgery.

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. S42.136 provides a clear distinction for nondisplaced fractures, which aids in treatment planning and outcomes tracking.

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. S42.136 provides a clear distinction for nondisplaced fractures, which aids in treatment planning and outcomes tracking.

Reimbursement & Billing Impact

reimbursement processes. S42.136 provides a clear distinction for nondisplaced fractures, which aids in treatment planning and outcomes tracking.

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 primary treatment for a nondisplaced fracture of the coracoid process?

The primary treatment typically involves conservative management, including rest, ice, and pain management. Surgical intervention may be considered if there are complications or associated injuries.