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v1.0.0
ICD-10 Guide
ICD-10 CodesS42.156

S42.156

Billable

Nondisplaced fracture of neck of scapula, unspecified shoulder

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

Code Description

ICD-10 S42.156 is a billable code used to indicate a diagnosis of nondisplaced fracture of neck of scapula, unspecified 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 separation of the bone fragments. This type of fracture typically occurs due to trauma, such as falls or direct blows 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 help differentiate between displaced and nondisplaced fractures. Treatment usually involves conservative management, including rest, ice, and physical therapy, although surgical intervention may be necessary in cases of associated injuries or complications. Understanding the nuances of this injury is essential for accurate coding and appropriate management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between displaced and nondisplaced fractures
  • Identifying associated injuries (e.g., rotator cuff tears)
  • Understanding the anatomical terminology related to the scapula
  • Variability in clinical presentation and imaging findings

Audit Risk Factors

  • Inadequate documentation of the fracture type
  • Failure to document associated injuries or complications
  • Misclassification of fracture displacement
  • Inconsistent coding across different providers

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

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

Common Clinical Scenarios

Fractures due to 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, treatment plans, and progress notes.

Common Clinical Scenarios

Rehabilitation following nondisplaced fractures, focusing on restoring function.

Billing Considerations

Document functional limitations and goals for therapy.

Coding Guidelines

Inclusion Criteria

Use S42.156 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 S42.156 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, surgical

Clinical Scenario

Used in cases where surgical intervention is required for associated injuries.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should 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. S42.156 provides a clear distinction for nondisplaced fractures, which aids in treatment planning and outcome 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. S42.156 provides a clear distinction for nondisplaced fractures, which aids in treatment planning and outcome tracking.

Reimbursement & Billing Impact

reimbursement processes. S42.156 provides a clear distinction for nondisplaced fractures, which aids in treatment planning and outcome 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 difference between a displaced and nondisplaced fracture?

A displaced fracture involves a separation of the bone fragments, while a nondisplaced fracture means the bone remains aligned despite the fracture.