ICD code S42.152A – Displaced fracture of neck of left scapula

Key takeaways

S42.152A codes a displaced fracture of the neck of the left scapula at the initial encounter for a closed fracture.

When the record does not say whether the fracture is displaced, ICD-10-CM codes it as displaced. S42.152A is therefore the default, and S42.155A needs explicit nondisplacement language.

The 6th character sets laterality. S42.151A is the right shoulder, S42.152A is the left, and S42.153A is the unspecified shoulder.

The 7th character A covers active treatment of a closed fracture only. Use B for an open fracture, D, G, K or P for later care, and S for sequelae.

Displaced neck fractures are treated closed or open, so CPT 23570, 23575 and 23585 can all pair with S42.152A.

Pabau’s claims management software scrubs every claim for missing or invalid details before it goes to Claim.MD, Pabau’s US clearinghouse partner.

ICD-10 code S42.152A: Quick reference

ICD-10 code S42.152A identifies a displaced fracture of the neck of the left scapula at the initial encounter for a closed fracture. It is a billable ICD-10-CM code, valid for the current fiscal year. Use the table below to confirm the descriptor, classification and 7th character options before you assign it. Its neighbors in category S42 are listed in our searchable ICD-10-CM library.

What a displaced fracture of the neck of the left scapula means clinically

The neck of the scapula is the narrowed region connecting the scapular body to the glenoid cavity, the socket of the shoulder joint. ICD-10-CM gives each scapula site its own subcategory, so the location named in the radiology report decides which code family applies.

• S42.11-: Fracture of body of scapula
• S42.12-: Fracture of acromial process
• S42.13-: Fracture of coracoid process
• S42.14-: Fracture of glenoid cavity of scapula
• S42.15-: Fracture of neck of scapula, the family S42.152A belongs to

“Displaced” means the fracture fragments have shifted out of their anatomical alignment. The treating physician or radiologist makes that call, never the coder. The ICD-10-CM Official Guidelines add a default that matters here. A fracture not documented as displaced or nondisplaced is coded as displaced, so S42.152A also covers a left scapular neck fracture with no displacement qualifier.

A sports medicine practice seeing high-energy shoulder injuries will meet this code most often after falls, direct blows to the shoulder, or motor vehicle accidents.

• Neck of scapula: The constricted column between the scapular body and the glenoid, distinct from the acromion, coracoid and spine.
• Displaced: The fragments are out of alignment, or the record does not state displacement at all.
• Left: The 6th character 2 records the left shoulder. Right is S42.151A and the unspecified shoulder is S42.153A.
• Initial encounter: The 7th character A applies while the patient receives active treatment for a closed fracture, however many visits that takes.

Inclusions, exclusions, and coding notes for S42.152A

Knowing what falls inside and outside the S42 category prevents miscoding adjacent shoulder injuries.

What S42.152A includes

S42.152A captures closed, displaced fractures of the left scapular neck during active treatment. It also covers a left scapular neck fracture whose displacement the record leaves unstated. A fracture not documented as open or closed is coded as closed. If the documentation states “open”, the initial encounter takes 7th character B instead (S42.152B).

What S42.152A excludes

• Traumatic amputation of shoulder and upper arm: Coded to S48.-, an Excludes1 note for the whole S42 category.
• Periprosthetic fracture around a shoulder prosthesis: Coded to M97.3, an Excludes2 note for S42.
• Pathological fractures of the scapula: Coded to M84.4- through M84.6-, or to M80.- when the cause is osteoporosis.
• Traumatic dislocation without fracture: Coded to S43.- (dislocation and sprain of joints and ligaments of shoulder girdle).
• Fractures of other scapula sites or the clavicle: Coded to their own subcategories, such as S42.14- for the glenoid cavity or S42.0- for the clavicle.

ICD-10-CM also carries a “use additional code” instruction for this chapter. Report an external cause code alongside S42.152A to identify the mechanism, activity and place of occurrence. The CMS ICD-10-CM coding and reporting guidelines encourage this reporting. There is no national mandate, so whether it is required depends on state reporting rules and payer policy.

Understanding the 7th character: A, B, D, G, K, P, and S

The 7th character reflects the stage of care, not the number of visits. A patient seen ten times during active treatment of the same fracture still takes character A every time.

The move from A to D is a frequent 7th character error in orthopedic coding. Active treatment ends when the provider moves from fracture management to routine monitoring of healing. From that visit on, use D for uncomplicated healing, G if healing is lagging, or K or P if imaging confirms a union problem.

Laterality variants: S42.151A, S42.152A, and S42.153A

All three codes describe a displaced fracture of the neck of the scapula at the initial encounter for a closed fracture. They differ only in the 6th character, which records the side. Payer edits often flag unspecified laterality, so explicit side documentation protects the claim.

When documentation says “left shoulder” but does not name the scapula, review the imaging and operative reports. An X-ray or CT report stating “displaced fracture of the left scapular neck” supports S42.152A. So does “left scapular neck fracture” with no displacement qualifier.

Displaced vs nondisplaced: Choosing between S42.152A and S42.155A

S42.152A (displaced) and S42.155A (nondisplaced fracture of neck of scapula, left shoulder, initial encounter) differ by one clinical variable. That variable is whether the fragments have shifted from their anatomical position. The answer comes from the radiology report or the operative note, never from the coder’s judgment.

The nondisplaced family mirrors the displaced one. S42.154A is the right shoulder, S42.155A the left, and S42.156A the unspecified shoulder. A claim carrying S42.155A against a report that says only “scapular neck fracture” is the mismatch an imaging-based audit will flag. In that case, the defensible code is S42.152A. The grid below sets all six initial-encounter codes side by side.

Documentation requirements to support S42.152A

A coder needs five elements in the medical record before assigning ICD-10 code S42.152A. Missing any one of them creates grounds for denial on audit.

• Fracture site: The X-ray, CT or MRI report must name the neck of the scapula, not the body, glenoid, acromion or coracoid.
• Displacement status: The report states “displaced”, or it leaves displacement unstated, which defaults to displaced. A report stating “nondisplaced” points to S42.155A instead.
• Explicit left-side laterality: The clinical note, imaging report or operative note must name the left shoulder or left scapula. “Shoulder fracture” alone does not establish the side.
• Mechanism of injury: Document the event behind the injury, such as a fall or a direct blow. The matching external cause code depends on it.
• Encounter type: The note must show active fracture management. That justifies the 7th character A. Routine follow-up, such as a sling change or healing X-ray, takes D instead. AHA Coding Clinic publishes authoritative Q&A on fracture coding scenarios, and our guide to medical billing documentation covers the wider record.

CPT codes that pair with S42.152A and external cause codes

Three CPT codes cover the treatment of scapula fractures, and all three are plausible with a displaced neck fracture. The right one depends on what the treating physician documented doing, not on the displacement alone. Link the procedure code to ICD-10 code S42.152A through the claim’s diagnosis pointer.

Many displaced scapular neck fractures still heal well without surgery, so 23570 remains a frequent pairing. CPT 23585 with S42.152A is not unusual, because significant displacement is a recognized indication for fixation. Have the operative note record the degree of displacement and the surgical rationale, so the pairing is easy to support if a payer asks.

Common external cause pairings with S42.152A include the following codes.

• W01.-: Fall on same level from slipping, tripping and stumbling.
• W17.-: Other fall from one level to another.
• V40-V49: Car occupant injured in transport accident.
• Y93.-: Activity codes, such as the sport being played when the injury happened.

Per AAPC’s ICD-10-CM code database, external cause codes follow the injury code and are never the first-listed diagnosis. Add a place of occurrence code (Y92.-) when documentation supports it.

Pabau’s orthopedic claims management toolset supports multi-code claim construction and checks each claim for missing or invalid details before submission.

Step-by-step coding workflow for S42.152A

This six-step workflow turns the code definition into an assignment routine you can run against a patient record. Follow the steps in order, because each one narrows the code the next step confirms.

1. Confirm the fracture location is the neck of the scapula. The radiology report must name the scapular neck, not the body, glenoid, acromion or coracoid. If the location is ambiguous, query the radiologist before assigning any S42.15- code.
2. Confirm the displacement status. A report stating “displaced”, or giving no displacement qualifier, supports S42.152A. Only explicit nondisplacement language moves the code to S42.155A. Never infer displacement from the treatment method alone.
3. Confirm the laterality is left. The clinical note, imaging report or operative note must state the left side. “Left shoulder blade fracture” qualifies, while “shoulder fracture” does not. If the side is genuinely undocumented after a query, assign S42.153A.
4. Select the 7th character. Choose A for active treatment of a closed fracture, or B if it is documented as open. Use D, G, K or P once active treatment is complete, and S for sequelae. For most first-presentation orthopedic or emergency department encounters, A is correct.
5. Assign the external cause codes. Identify the mechanism from the history, such as a fall (W-codes), a motor vehicle accident (V-codes) or a sports injury. Add an activity code (Y93.-) and a place of occurrence code (Y92.-) when documentation supports them. Sequence them after S42.152A on the claim.
6. Verify CPT alignment. Match the procedure code to the documented treatment: 23570 for nonoperative care, 23575 for closed reduction, 23585 for open fixation. The clean claim submission standard requires the diagnosis to support the medical necessity of the procedure.

For coding compliance guidance, the CMS ICD-10-CM Official Guidelines remain the authoritative reference. The CDC/NCHS ICD-10-CM web tool confirms current-year code status and tabular notes. The AAPC ICD-10-CM lookup shows the full S42 hierarchy. Practices with billing compliance workflows built around these steps can record the coding rationale in the patient record, which supports appeals.

Common claim denials for ICD-10 code S42.152A and how to prevent them

The documentation rules above create five predictable denial patterns for this code. The table maps each one to its root cause, prevention step and appeal argument.

Tracking denials across all S42.15- claims, not just S42.152A, shows whether a problem is systematic. One example is a radiology template that never states displacement or laterality.

How Pabau keeps S42.152A claims clean before submission

In many practices, the coder checks the radiology report by hand and the claim goes out. An error on the side, the displacement or the 7th character then returns weeks later as a denial. Each one costs a resubmission and delays payment.

Pabau’s claim validation scrubs every claim for missing or invalid details before it leaves Pabau. If a claim still comes back rejected, Pabau flags it as needing action and links straight to the field to fix. The Claim.MD clearinghouse integration then submits claims, checks eligibility and tracks each claim through to payment or denial.

Electronic remittance advice comes back into Pabau, so payments and denials sit next to the claim that produced them. That makes it easier to run a denial management workflow that fixes recurring patterns rather than single claims.

Stop catching S42.152A denials after the fact

Pabau scrubs every claim for missing or invalid details before it leaves your practice, then submits it through Claim.MD. See how orthopedic and sports medicine practices fix errors before the payer sees them.

Book a demo

Conclusion

S42.152A is the default code for a closed left scapular neck fracture in active treatment. It applies whether the report says “displaced” or says nothing about displacement. That default is what makes it defensible. The riskier move is reaching for S42.155A without the word “nondisplaced” in the imaging report.

Build the check into your routine: Site, displacement, side, stage of care, then the procedure. Do it before the claim leaves, and most S42.152A denials never happen. Book a demo to see how Pabau validates fracture claims before they reach the payer.

Continue your research

Need a framework for managing claim denials systematically? Denial codes in medical billing covers the most common CARC codes and how to build a denial tracking workflow.

Want to understand how clearinghouse edits catch errors before submission? How a medical claims clearinghouse works explains the validation layer between your practice and the payer.

Looking for guidance on insurance eligibility verification before the encounter? Insurance eligibility verification walks through the pre-visit workflow that reduces downstream claim issues.

Frequently asked questions