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ICD-10 Guide
ICD-10 CodesS42.154

S42.154

Billable

Nondisplaced fracture of neck of scapula, right shoulder

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

Code Description

ICD-10 S42.154 is a billable code used to indicate a diagnosis of nondisplaced fracture of neck of scapula, right shoulder.

Key Diagnostic Point:

A nondisplaced fracture of the neck of the scapula is characterized by a break in the bone that does not result in the bone fragments being misaligned. This type of fracture typically occurs due to trauma, such as a fall or direct impact to the shoulder area. The scapula, or shoulder blade, plays a crucial role in shoulder mobility and stability, and fractures in this area can lead to pain, limited range of motion, and potential complications if not properly managed. Patients may present with shoulder pain, swelling, and difficulty moving the arm. Diagnosis is often confirmed through imaging studies, such as X-rays or CT scans, which can reveal the fracture's location and severity. Treatment usually involves conservative management, including rest, ice, immobilization, and physical therapy. In some cases, surgical intervention may be necessary if the fracture leads to significant instability or if there are associated injuries to the surrounding structures, such as the rotator cuff or humerus. Understanding the implications of a nondisplaced fracture of the scapula is essential for effective treatment and rehabilitation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Understanding associated injuries to the shoulder complex
  • Variability in treatment approaches based on patient age and activity level
  • Documentation of imaging studies and clinical findings

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the nondisplaced nature of the fracture
  • Lack of imaging reports to support the diagnosis
  • Inconsistent treatment documentation

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging studies, and follow-up care plans.

Common Clinical Scenarios

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

Billing Considerations

Ensure clear documentation of fracture type and any associated injuries to the shoulder complex.

Physical Therapy

Documentation Requirements

Progress notes detailing range of motion, strength assessments, and rehabilitation protocols.

Common Clinical Scenarios

Patients recovering from shoulder fractures undergoing rehabilitation.

Billing Considerations

Document functional limitations and progress towards rehabilitation goals.

Coding Guidelines

Inclusion Criteria

Use S42.154 When
  • Follow the official ICD
  • CM guidelines for coding fractures, ensuring accurate documentation of the fracture type, location, and any associated injuries
  • Include details about the mechanism of injury and treatment plan

Exclusion Criteria

Do NOT use S42.154 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, diagnostic

Clinical Scenario

Used when assessing shoulder injuries, including fractures.

Documentation Requirements

Document indications for the procedure and findings.

Specialty Considerations

Orthopedic surgeons should ensure clear documentation of the diagnosis and procedure 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, improving the accuracy of data collection and reimbursement processes. S42.154 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 shoulder injuries, improving the accuracy of data collection and reimbursement processes. S42.154 provides a clear distinction between nondisplaced and displaced fractures, which is crucial for treatment planning.

Reimbursement & Billing Impact

reimbursement processes. S42.154 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 in the bone where the fragments are misaligned, while a nondisplaced fracture means the bone remains in its normal position despite the fracture.