2026 ICD-10-CM Diagnosis Code S02.842AFracture of lateral orbital wall, left side, initial encounter for closed fracture
ICD-10-CM Codes›S00–T88›S00-S09›S02
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 399
- 7th Character A — Initial Encounter
- Not Chronic
S02.842A is a billable ICD-10-CM diagnosis code for fracture of lateral orbital wall, left side, initial encounter for closed fracture. The 7th character A marks it as an initial encounter code, used while the patient is receiving active treatment. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 11 through 13, 82 through 87, 963 through 965. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 413 closely related codes. Coders also document this condition as closed fracture of left orbit. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Fracture of head and neck, initial encounter.
For Medicare Advantage risk adjustment, S02.842A maps to CMS-HCC Category 399 (Major Head Injury without Loss of Consciousness) under the V28 model, adding a risk factor of about 0.199 for a community, non-dual, aged beneficiary in payment year 2026.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
S02.842A maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2026.
Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Closed fracture of left orbit
- Fracture of lateral wall of orbit
- Left lateral orbit wall closed fracture
- Open fracture of lateral wall of orbit
- Open fracture of left lateral orbital wall
- Open fracture of left orbit
Coding GuidelinesGuidance
The principles of multiple coding of injuries should be followed in coding fractures. Fractures of specified sites are coded individually by site, to 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) while 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).
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).
Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026, published by CMS and the National Center for Health Statistics.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Facial Injuries and Disorders
Face injuries and disorders can cause pain and affect how you look. In severe cases, they can affect sight, speech, breathing and your ability to swallow. Fractures (broken bones), especially in the bones of your nose, cheekbone and jaw, are common facial injuries.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Code History & ChangesHistory
Replacement S02.842A replaces the following previously assigned code(s):
- S02.82XA - Fracture of oth skull and facial bones, left side, init
Questions About S02.842AOverview
Is S02.842A (Fracture of lateral orbital wall, left side) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report fracture of lateral orbital wall, left side, initial encounter for closed fracture on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What does the 7th character A in S02.842A mean?
The final character A marks the initial encounter: use it while the patient is receiving active treatment for fracture of lateral orbital wall, left side, such as an emergency visit or first evaluation.
What MS-DRG does S02.842A group to?
When fracture of lateral orbital wall, left side, initial encounter for closed fracture is the principal diagnosis on an inpatient stay, it groups to MS-DRG 11, 12, 13, 82, 83, 84, 85, 86, 87, 963, 964, 965, with relative weights from 0.9147 to 5.4541 depending on complications. Higher weights mean higher Medicare reimbursement.
Is S02.842A a CC or MCC?
CMS lists S02.842A as a CC (complication or comorbidity) for FY 2026. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 413 closely related codes in its exclusion list.
What HCC is S02.842A?
S02.842A (fracture of lateral orbital wall, left side, initial encounter for closed fracture) maps to CMS-HCC Category 399 (Major Head Injury without Loss of Consciousness), commonly written as HCC 399, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 167 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.
Does S02.842A risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, S02.842A adds a risk adjustment factor of about 0.199 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.052 to 0.349 depending on the payment segment). A more severe related category (HCC 397 and HCC 398) supersedes it when both are reported. See the full factor table on the HCC 399 category page.
