ICD-10-CM Billable Code

S42.11

Fracture of body of scapula

Clinical Classification Guidelines

Medical Intelligence & Overview

A fracture of the body of the scapula is a break in the shoulder blade, which is a flat, triangular bone located on the upper back. This type of fracture can result from direct trauma or a fall and can affect shoulder mobility and stability. Recognizing the symptoms and understanding the causes are essential steps toward proper management of this injury. Although some cases may require surgical intervention, many fractures heal with appropriate medical care and rest.

Causes & Symptoms

Clinical Causes: Direct blow or trauma to the shoulder area, such as a fall or car accident. High-impact sports injuries or accidents involving heavy machinery. Falls onto the shoulder or outstretched arm. Trauma from physical assault or blunt force impacts.

Key Symptoms: Pain and tenderness around the shoulder and upper back. Swelling in the shoulder region. Limited range of motion or difficulty moving the arm. Visible deformity or an abnormal bump if the fracture is displaced. Bruising or discoloration over the shoulder and upper back. Weakness in the arm and shoulder muscles.

Diagnostic & Treatment

Diagnosis Path: To confirm a fracture of the scapula, healthcare providers typically perform a physical examination and may request imaging tests. Common diagnostic tools include:

Treatment Protocols: Appropriate treatment options are determined based on the severity and location of the fracture. Common approaches include:

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.

Clinical Advice & FAQs

Billing Guidance

Is S42.11 a billable ICD-10 code?
Yes, S42.11 is a specific, billable code that can be used to indicate a diagnosis for reimbursement purposes.

Documentation

How do I report S42.11?
Clinical documentation must specify the nature of Fracture of body of scapula and any associated comorbidities for accurate reporting.

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