ICD-10 Coding for Distal Clavicle Fracture(S42.031, S42.034)
Complete ICD-10-CM coding and documentation guide for Distal Clavicle Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Distal Clavicle Fracture
S42.03Primary Range
Fracture of the lateral end of the clavicle
This range includes specific codes for fractures of the distal (lateral) end of the clavicle, which is the focus of this documentation.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S42.031 | Displaced fracture of lateral end of right clavicle | Use when a displaced fracture of the lateral end of the right clavicle is confirmed by imaging. |
|
| S42.034 | Nondisplaced fracture of lateral end of right clavicle | Use when a nondisplaced fracture of the lateral end of the right clavicle is confirmed by imaging. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for distal clavicle fracture
Essential facts and insights about Distal Clavicle Fracture
Primary ICD-10-CM Codes for distal clavicle fracture
Decision Criteria
clinical Criteria
- Imaging confirms fracture at lateral end with displacement
documentation Criteria
- Documentation specifies 'displaced' and 'lateral end'
Applicable To
- Displaced fracture of acromial end of right clavicle
Clinical Validation Requirements
- Imaging confirming fracture location at the lateral end
- Documentation of displacement status
Code-Specific Risks
- Misclassification as a midshaft fracture
- Omission of displacement status
Coding Notes
- Ensure documentation specifies 'lateral end' and displacement status.
S42.034 - Nondisplaced fracture of lateral end of right clavicle
Use when a nondisplaced fracture of the lateral end of the right clavicle is confirmed by imaging.
Applicable To
- Nondisplaced fracture of acromial end of right clavicle
Excludes
- Fracture of shaft of clavicle (S42.02-)
- Fracture of sternal end of clavicle (S42.01-)
Clinical Validation Requirements
- Imaging confirming fracture location at the lateral end
- Documentation of nondisplacement status
Coding Notes
Ensure documentation specifies 'lateral end' and nondisplacement status.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Fall from slipping, tripping, or stumbling
W19.XXXADifferential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Fracture of clavicle shaft
S42.021Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Distal Clavicle Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S42.031.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims or reduced reimbursement.
Mitigation Strategy
Include displacement status in all fracture documentation., Verify with imaging reports.
Impact
Reimbursement: Incorrect DRG assignment may lead to improper reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Ensure documentation specifies 'lateral end' and confirm with imaging.
Impact
Audits may target incorrect coding of clavicle fractures due to lack of specificity.
Mitigation Strategy
Ensure detailed documentation specifying fracture location and displacement.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Distal Clavicle Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Distal Clavicle Fracture
Use these documentation templates to ensure complete and accurate documentation for Distal Clavicle Fracture. These templates include all required elements for proper coding and billing.
Initial encounter for a displaced distal clavicle fracture
Specialty: OrthopedicsRequired Elements
- Patient demographics
- Mechanism of injury
- Imaging results
- Displacement status
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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