2025 ICD-10-CM Diagnosis Code S22.038B
Other fracture of third thoracic vertebra, initial encounter for open fracture
- ICD-10-CM Code:
- S22.038B
- ICD-10 Code for:
- Oth fracture of third thoracic vertebra, init for opn fx
- Is Billable?
- Yes - Valid for Submission
- Chronic Condition Indicator: [1]
- Not chronic
- Code Navigator:
S22.038B is a billable diagnosis code used to specify a medical diagnosis of other fracture of third thoracic vertebra, initial encounter for open fracture. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2024 through September 30, 2025.
S22.038B is an initial encounter code, includes a 7th character and should be used while the patient is receiving active treatment for a condition like other fracture of third thoracic vertebra for open fracture. According to ICD-10-CM Guidelines an "initial encounter" doesn't necessarily means "initial visit". The 7th character should be used when the patient is undergoing active treatment regardless if new or different providers saw the patient over the course of a treatment. The appropriate 7th character codes should also be used even if the patient delayed seeking treatment for a condition.
The code is linked to some Quality Measures as part of Medicare's Quality Payment Program (QPP). When this code is used as part of a patient's medical record the following Quality Measures might apply: Communication With The Physician Or Other Clinician Managing On-going Care Post-fracture For Men And Women Aged 50 Years And Older , Osteoporosis Management In Women Who Had A Fracture.
Clinical Classification
Clinical Category is Fracture of the spine and back, initial encounter
- CCSR Category Code: INJ002
- Inpatient Default CCSR: Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis.
- Outpatient Default CCSR: Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.
Coding Guidelines
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).
Convert S22.038B to ICD-9-CM
- ICD-9-CM Code: 805.3 - Fx dorsal vertebra-open
Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code.
Quality Payment Program Measures
When code S22.038B is part of the patient's diagnoses the following Quality Measures apply and affect reimbursement. The objective of Medicare's Quality Measures is to improve patient care by making it more: effective, safe, efficient, patient-centered and equitable.
| Quality Measure | Description | Measure Type | High Priority | Submission Methods |
|---|---|---|---|---|
| Communication with the Physician or Other Clinician Managing On-Going Care Post-Fracture for Men and Women Aged 50 Years and Older | Percentage of patients aged 50 years and older treated for a fracture with documentation of communication, between the physician treating the fracture and the physician or other clinician managing the patient's on-going care, that a fracture occurred and that the patient was or should be considered for osteoporosis treatment or testing. This measure is submitted by the physician who treats the fracture and who therefore is held accountable for the communication. | Process | YES | Claims, Registry |
| Osteoporosis Management in Women Who Had a Fracture | The percentage of women 50-85 years of age who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis in the six months after the fracture. | Process | NO | Claims, Registry |
Patient Education
Fractures
What is a fracture?
A fracture is a break in a bone. Fractures are usually caused by injuries. Since they can sometimes be serious, it's important to get medical care right away if you think you have a fracture.
What are the different types of fractures?
There are different ways to describe fractures. For example, there are different types of fractures based on:
- Whether the bone is partially or completely broken.
- Whether the bone breaks through the skin; if it does, it's called an open (or compound) fracture. If not, it's a closed fracture.
- The direction or shape of the break, for example if it's in a line across the bone or if it has some kind of pattern.
- The cause of the break. For example, a stress fracture is a small break in a bone that is often caused by overuse.
- Which bone is broken, for example facial fractures include nose and jaw fractures.
What causes fractures?
Fractures commonly happen because of car accidents, falls, or sports injuries. Overuse and repetitive motions can also cause fractures.
Low bone density and osteoporosis are conditions which cause weakening of your bones. Having one of these conditions makes you much more likely to break a bone.
What are the symptoms of a fracture?
The symptoms of a fracture can vary, depending on which bone you broke. But they may include:
- Intense pain
- Deformity, for example a limb that looks out of place
- Swelling, bruising, or tenderness around the injury
- Trouble moving the injured part
If you think that you may have broken a bone, get medical care right away.
How are fractures diagnosed?
To find out if you have a fracture, your health provider will do a physical exam and ask about your injury. They will also likely order an x-ray or other imaging test to see if your bone is broken.
What are the treatments for fractures?
The most common treatment for a fracture is for you to wear a cast or a splint. This will keep your bone from moving while it heals. How long you need to wear it will depend on the type of fracture and which bone is affected. But it's often for several weeks. Your provider will let you when you can get it off.
In some cases, you may need surgery to put in plates, pins, or screws to keep the bone in place.
Can fractures be prevented?
There are steps you can take to lower your risk of fractures:
- Keeping your bones strong by:
- Getting enough calcium and vitamin D in your diet
- Getting regular physical activity, including weight bearing exercises such as walking, tennis, and dancing
- Getting treatment for low bone density or osteoporosis (if needed)
- Wearing protective equipment when you do sports
- Preventing falls by:
- Getting rid of any tripping hazards in your home
- Being careful when walking on wet or icy surfaces
- Choosing the right footwear
[Learn More in MedlinePlus]
Spine Injuries and Disorders
Your backbone, or spine, is made up of 26 bone discs called vertebrae. The vertebrae protect your spinal cord and allow you to stand and bend. A number of problems can change the structure of the spine or damage the vertebrae and surrounding tissue. They include:
- Infections
- Injuries
- Tumors
- Conditions, such as ankylosing spondylitis and scoliosis
- Bone changes that come with age, such as spinal stenosis and herniated disks
Spinal diseases often cause pain when bone changes put pressure on the spinal cord or nerves. They can also limit movement. Treatments differ by disease, but sometimes they include back braces and surgery.
[Learn More in MedlinePlus]
Code History
- FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
- FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
- FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
- FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
- FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
- FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
- FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
- FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
- FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.
Footnotes
[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.
