2021 ICD-10-CM Code S42.1

Fracture of scapula

Version 2021

Not Valid for Submission

S42.1 is a non-specific and non-billable diagnosis code code, consider using a code with a higher level of specificity for a diagnosis of fracture of scapula. The code is not specific and is NOT valid for the year 2021 for the submission of HIPAA-covered transactions. Category or Header define the heading of a category of codes that may be further subdivided by the use of 4th, 5th, 6th or 7th characters.

ICD-10:S42.1
Short Description:Fracture of scapula
Long Description:Fracture of scapula

Code Classification

Coding Guidelines

The principles of multiple coding of injuries should be followed in coding fractures. Fractures of specified sites are coded individually by site nd the level of detail furnished by medical record content.

A fracture not indicated as open or closed should be coded to closed. A fracture not indicated whether displaced or not displaced should be coded to displaced.

Initial vs. Subsequent Encounter for Fractures

Traumatic fractures are coded using the appropriate 7th character for initial encounter (A, B, C) for each encounter where the patient is receiving active treatment for the fracture. The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.

Fractures are coded using the appropriate 7th character for subsequent care for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase.

Care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes.

Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate 7th character for subsequent care with nonunion (K, M, N,) or subsequent care with malunion (P, Q, R).

Malunion/nonunion: The appropriate 7th character for initial encounter should also be assigned for a patient who delayed seeking treatment for the fracture or nonunion.

The open fracture designations in the assignment of the 7th character for fractures of the forearm, femur and lower leg, including ankle are based on the Gustilo open fracture classification. When the Gustilo classification type is not specified for an open fracture, the 7th character for open fracture type I or II should be assigned (B, E, H, M, Q).

Specific Coding for Fracture of scapula

Non-specific codes like S42.1 require more digits to indicate the appropriate level of specificity. Consider using any of the following ICD-10 codes with a higher level of specificity when coding for fracture of scapula:

  • NON-BILLABLE CODE - S42.10 for Fracture of unspecified part of scapula
  • NON-BILLABLE CODE - S42.101 for Fracture of unspecified part of scapula, right shoulder
  • BILLABLE CODE - Use S42.101A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.101B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.101D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.101G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.101K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.101P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.101S for sequela
  • NON-BILLABLE CODE - S42.102 for Fracture of unspecified part of scapula, left shoulder
  • BILLABLE CODE - Use S42.102A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.102B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.102D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.102G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.102K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.102P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.102S for sequela
  • NON-BILLABLE CODE - S42.109 for Fracture of unspecified part of scapula, unspecified shoulder
  • BILLABLE CODE - Use S42.109A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.109B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.109D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.109G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.109K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.109P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.109S for sequela
  • NON-BILLABLE CODE - S42.11 for Fracture of body of scapula
  • NON-BILLABLE CODE - S42.111 for Displaced fracture of body of scapula, right shoulder
  • BILLABLE CODE - Use S42.111A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.111B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.111D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.111G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.111K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.111P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.111S for sequela
  • NON-BILLABLE CODE - S42.112 for Displaced fracture of body of scapula, left shoulder
  • BILLABLE CODE - Use S42.112A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.112B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.112D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.112G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.112K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.112P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.112S for sequela
  • NON-BILLABLE CODE - S42.113 for Displaced fracture of body of scapula, unspecified shoulder
  • BILLABLE CODE - Use S42.113A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.113B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.113D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.113G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.113K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.113P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.113S for sequela
  • NON-BILLABLE CODE - S42.114 for Nondisplaced fracture of body of scapula, right shoulder
  • BILLABLE CODE - Use S42.114A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.114B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.114D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.114G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.114K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.114P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.114S for sequela
  • NON-BILLABLE CODE - S42.115 for Nondisplaced fracture of body of scapula, left shoulder
  • BILLABLE CODE - Use S42.115A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.115B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.115D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.115G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.115K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.115P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.115S for sequela
  • NON-BILLABLE CODE - S42.116 for Nondisplaced fracture of body of scapula, unspecified shoulder
  • BILLABLE CODE - Use S42.116A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.116B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.116D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.116G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.116K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.116P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.116S for sequela
  • NON-BILLABLE CODE - S42.12 for Fracture of acromial process
  • NON-BILLABLE CODE - S42.121 for Displaced fracture of acromial process, right shoulder
  • BILLABLE CODE - Use S42.121A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.121B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.121D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.121G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.121K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.121P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.121S for sequela
  • NON-BILLABLE CODE - S42.122 for Displaced fracture of acromial process, left shoulder
  • BILLABLE CODE - Use S42.122A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.122B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.122D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.122G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.122K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.122P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.122S for sequela
  • NON-BILLABLE CODE - S42.123 for Displaced fracture of acromial process, unspecified shoulder
  • BILLABLE CODE - Use S42.123A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.123B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.123D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.123G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.123K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.123P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.123S for sequela
  • NON-BILLABLE CODE - S42.124 for Nondisplaced fracture of acromial process, right shoulder
  • BILLABLE CODE - Use S42.124A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.124B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.124D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.124G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.124K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.124P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.124S for sequela
  • NON-BILLABLE CODE - S42.125 for Nondisplaced fracture of acromial process, left shoulder
  • BILLABLE CODE - Use S42.125A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.125B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.125D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.125G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.125K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.125P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.125S for sequela
  • NON-BILLABLE CODE - S42.126 for Nondisplaced fracture of acromial process, unspecified shoulder
  • BILLABLE CODE - Use S42.126A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.126B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.126D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.126G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.126K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.126P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.126S for sequela
  • NON-BILLABLE CODE - S42.13 for Fracture of coracoid process
  • NON-BILLABLE CODE - S42.131 for Displaced fracture of coracoid process, right shoulder
  • BILLABLE CODE - Use S42.131A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.131B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.131D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.131G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.131K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.131P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.131S for sequela
  • NON-BILLABLE CODE - S42.132 for Displaced fracture of coracoid process, left shoulder
  • BILLABLE CODE - Use S42.132A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.132B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.132D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.132G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.132K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.132P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.132S for sequela
  • NON-BILLABLE CODE - S42.133 for Displaced fracture of coracoid process, unspecified shoulder
  • BILLABLE CODE - Use S42.133A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.133B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.133D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.133G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.133K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.133P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.133S for sequela
  • NON-BILLABLE CODE - S42.134 for Nondisplaced fracture of coracoid process, right shoulder
  • BILLABLE CODE - Use S42.134A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.134B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.134D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.134G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.134K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.134P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.134S for sequela
  • NON-BILLABLE CODE - S42.135 for Nondisplaced fracture of coracoid process, left shoulder
  • BILLABLE CODE - Use S42.135A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.135B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.135D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.135G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.135K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.135P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.135S for sequela
  • NON-BILLABLE CODE - S42.136 for Nondisplaced fracture of coracoid process, unspecified shoulder
  • BILLABLE CODE - Use S42.136A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.136B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.136D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.136G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.136K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.136P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.136S for sequela
  • NON-BILLABLE CODE - S42.14 for Fracture of glenoid cavity of scapula
  • NON-BILLABLE CODE - S42.141 for Displaced fracture of glenoid cavity of scapula, right shoulder
  • BILLABLE CODE - Use S42.141A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.141B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.141D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.141G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.141K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.141P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.141S for sequela
  • NON-BILLABLE CODE - S42.142 for Displaced fracture of glenoid cavity of scapula, left shoulder
  • BILLABLE CODE - Use S42.142A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.142B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.142D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.142G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.142K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.142P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.142S for sequela
  • NON-BILLABLE CODE - S42.143 for Displaced fracture of glenoid cavity of scapula, unspecified shoulder
  • BILLABLE CODE - Use S42.143A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.143B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.143D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.143G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.143K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.143P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.143S for sequela
  • NON-BILLABLE CODE - S42.144 for Nondisplaced fracture of glenoid cavity of scapula, right shoulder
  • BILLABLE CODE - Use S42.144A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.144B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.144D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.144G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.144K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.144P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.144S for sequela
  • NON-BILLABLE CODE - S42.145 for Nondisplaced fracture of glenoid cavity of scapula, left shoulder
  • BILLABLE CODE - Use S42.145A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.145B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.145D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.145G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.145K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.145P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.145S for sequela
  • NON-BILLABLE CODE - S42.146 for Nondisplaced fracture of glenoid cavity of scapula, unspecified shoulder
  • BILLABLE CODE - Use S42.146A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.146B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.146D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.146G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.146K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.146P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.146S for sequela
  • NON-BILLABLE CODE - S42.15 for Fracture of neck of scapula
  • NON-BILLABLE CODE - S42.151 for Displaced fracture of neck of scapula, right shoulder
  • BILLABLE CODE - Use S42.151A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.151B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.151D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.151G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.151K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.151P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.151S for sequela
  • NON-BILLABLE CODE - S42.152 for Displaced fracture of neck of scapula, left shoulder
  • BILLABLE CODE - Use S42.152A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.152B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.152D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.152G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.152K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.152P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.152S for sequela
  • NON-BILLABLE CODE - S42.153 for Displaced fracture of neck of scapula, unspecified shoulder
  • BILLABLE CODE - Use S42.153A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.153B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.153D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.153G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.153K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.153P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.153S for sequela
  • NON-BILLABLE CODE - S42.154 for Nondisplaced fracture of neck of scapula, right shoulder
  • BILLABLE CODE - Use S42.154A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.154B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.154D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.154G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.154K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.154P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.154S for sequela
  • NON-BILLABLE CODE - S42.155 for Nondisplaced fracture of neck of scapula, left shoulder
  • BILLABLE CODE - Use S42.155A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.155B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.155D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.155G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.155K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.155P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.155S for sequela
  • NON-BILLABLE CODE - S42.156 for Nondisplaced fracture of neck of scapula, unspecified shoulder
  • BILLABLE CODE - Use S42.156A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.156B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.156D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.156G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.156K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.156P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.156S for sequela
  • NON-BILLABLE CODE - S42.19 for Fracture of other part of scapula
  • NON-BILLABLE CODE - S42.191 for Fracture of other part of scapula, right shoulder
  • BILLABLE CODE - Use S42.191A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.191B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.191D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.191G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.191K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.191P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.191S for sequela
  • NON-BILLABLE CODE - S42.192 for Fracture of other part of scapula, left shoulder
  • BILLABLE CODE - Use S42.192A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.192B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.192D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.192G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.192K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.192P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.192S for sequela
  • NON-BILLABLE CODE - S42.199 for Fracture of other part of scapula, unspecified shoulder
  • BILLABLE CODE - Use S42.199A for initial encounter for closed fracture
  • BILLABLE CODE - Use S42.199B for initial encounter for open fracture
  • BILLABLE CODE - Use S42.199D for subsequent encounter for fracture with routine healing
  • BILLABLE CODE - Use S42.199G for subsequent encounter for fracture with delayed healing
  • BILLABLE CODE - Use S42.199K for subsequent encounter for fracture with nonunion
  • BILLABLE CODE - Use S42.199P for subsequent encounter for fracture with malunion
  • BILLABLE CODE - Use S42.199S for sequela

Information for Patients


Fractures

Also called: Broken bone

A fracture is a break, usually in a bone. If the broken bone punctures the skin, it is called an open or compound fracture. Fractures commonly happen because of car accidents, falls, or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Overuse can cause stress fractures, which are very small cracks in the bone.

Symptoms of a fracture are

You need to get medical care right away for any fracture. An x-ray can tell if your bone is broken. You may need to wear a cast or splint. Sometimes you need surgery to put in plates, pins or screws to keep the bone in place.


[Learn More in MedlinePlus]

Shoulder Injuries and Disorders

Your shoulder joint is composed of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). Your shoulders are the most movable joints in your body. They can also be unstable because the ball of the upper arm is larger than the shoulder socket that holds it. To remain in a stable or normal position, the shoulder must be anchored by muscles, tendons, and ligaments.

Because your shoulder can be unstable, it can be easily injured. Common problems include

Health care providers diagnose shoulder problems by using your medical history, a physical exam, and imaging tests.

Often, the first treatment for shoulder problems is RICE. This stands for Rest, Ice, Compression, and Elevation. Other treatments include exercise and medicines to reduce pain and swelling. If those don't work, you may need surgery.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases


[Learn More in MedlinePlus]

Code History

  • FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016 (First year ICD-10-CM implemented into the HIPAA code set)