Valid for Submission
S02.5XXD is a billable diagnosis code used to specify a medical diagnosis of fracture of tooth (traumatic), subsequent encounter for fracture with routine healing. The code S02.5XXD is valid during the fiscal year 2022 from October 01, 2021 through September 30, 2022 for the submission of HIPAA-covered transactions.
The ICD-10-CM code S02.5XXD might also be used to specify conditions or terms like broken tooth with complication, broken tooth without complication, complicated tooth crown and root fracture, enamel and dentine fracture, exposure of tooth pulp , fracture of crown and root of tooth, etc. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.
S02.5XXD is a subsequent encounter code, includes a 7th character and should be used after the patient has completed active treatment for a condition like fracture of tooth (traumatic) for fracture with routine healing. According to ICD-10-CM Guidelines a "subsequent encounter" occurs when the patient is receiving routine care for the condition during the healing or recovery phase of treatment. Subsequent diagnosis codes are appropriate during the recovery phase, no matter how many times the patient has seen the provider for this condition. If the provider needs to adjust the patient's care plan due to a setback or other complication, the encounter becomes active again.
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).
The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:
- Broken tooth with complication
- Broken tooth without complication
- Complicated tooth crown and root fracture
- Enamel and dentine fracture
- Exposure of tooth pulp
- Fracture of crown and root of tooth
- Fracture of crown of tooth, enamel and dentin, with pulp exposure
- Fracture of crown of tooth, enamel and dentin, without pulp exposure
- Fracture of crown of tooth, enamel only
- Fracture of cusp of tooth during masticatory loading
- Fracture of dental root
- Fracture of fissure of tooth
- Fracture of migrated tooth
- Fracture of root of tooth at bifurcation
- Fracture of tooth
- Horizontal fracture of apical third of root of tooth
- Horizontal fracture of cervical third of root of tooth
- Horizontal fracture of middle third of root of tooth
- Horizontal fracture of tooth
- Incomplete fracture of tooth
- Insufficient clinical crown height due to fracture
- Multiple root fractures
- Open fracture of tooth
- Periodontitis due to fracture of root of tooth
- Tooth crown fracture
- Uncomplicated tooth crown and root fracture
- Uncomplicated tooth crown fracture
- Vertical fracture of root of tooth
- Vertical fracture of tooth extending into pulp of tooth
- Vertical fracture of tooth without pulp involvement
Diagnostic Related Groups - MS-DRG Mapping
|MS-DRG||MS-DRG Title||MCD||Relative Weight|
|559||AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC||08||1.8679|
|560||AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC||08||1.0764|
|561||AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC||08||0.7911|
The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.
Present on Admission (POA)
Convert S02.5XXD to ICD-9 Code
The General Equivalency Mapping (GEM) crosswalk indicates an approximate mapping between the ICD-10 code S02.5XXD its ICD-9 equivalent. The approximate mapping means there is not an exact match between the ICD-10 code and the ICD-9 code and the mapped code is not a precise representation of the original code.
Information for Patients
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
- Intense pain
- Deformity - the limb looks out of place
- Swelling, bruising, or tenderness around the injury
- Numbness and tingling
- Problems moving a limb
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]
What are teeth?
Your teeth are made of a hard, bonelike material. There are four parts:
- Enamel, your tooth's hard surface
- Dentin, the hard yellow part under the enamel
- Cementum, the hard tissue that covers the root and keeps your teeth in place
- Pulp, the soft connective tissue in the center of your tooth. It contains nerves and blood vessels.
You need your teeth for many activities that you may take for granted. These include eating, speaking and even smiling.
What are tooth disorders?
There are many different problems that can affect your teeth, including
- Tooth decay - damage to a tooth's surface, which can lead to cavities
- Abscess - a pocket of pus, caused by a tooth infection
- Impacted tooth - a tooth did not erupt (break through the gum) when it should have. It is usually wisdom teeth that are impacted, but it can sometimes happen to other teeth.
- Misaligned teeth (malocclusion)
- Tooth injuries such as broken or chipped teeth
What causes tooth disorders?
The causes of tooth disorders varies, depending on the problem. Sometimes the cause is not taking good care of your teeth. In other cases, you may have been born with the problem or the cause is an accident.
What are the symptoms of tooth disorders?
The symptoms can vary, depending on the problem. Some of the more common symptoms include
- Abnormal color or shape of the tooth
- Tooth pain
- Worn-down teeth
How are tooth disorders diagnosed?
Your dentist will ask about your symptoms, look at your teeth, and probe them with dental instruments. In some cases, you may need dental x-rays.
What are the treatments for tooth disorders?
The treatment will depend on the problem. Some common treatments are
- Fillings for cavities
- Root canals for cavities or infections that affect the pulp (inside of the tooth)
- Extractions (pulling teeth) for teeth that are impacted and causing problems or are too damaged to be fixed. You may also have a tooth or teeth pulled because of overcrowding in your mouth.
Can tooth disorders be prevented?
The main thing that you can do to prevent tooth disorders is to take good care of your teeth:
- Brush your teeth twice a day with a fluoride toothpaste
- Clean between your teeth every day with floss or another type of between-the-teeth cleaner
- Limit sugary snacks and drinks
- Don't smoke or chew tobacco
- See your dentist or oral health professional regularly
[Learn More in MedlinePlus]