ICD-10 Coding for Fractured Tooth(S02.5XXA, K03.81)
Complete ICD-10-CM coding and documentation guide for Fractured Tooth. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fractured Tooth
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S02.5XXA | Fracture of tooth, initial encounter | Use for initial encounters of traumatic tooth fractures. |
|
| K03.81 | Cracked tooth (non-traumatic) | Use for non-traumatic cracks in teeth. |
|
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 fractured tooth
Essential facts and insights about Fractured Tooth
Primary ICD-10-CM Codes for fractured tooth
Decision Criteria
clinical Criteria
- Presence of trauma history and acute symptoms
coding Criteria
- Use of seventh character for encounter type
Applicable To
- Traumatic tooth fracture
Excludes
- Cracked tooth (nontraumatic) (K03.81)
Clinical Validation Requirements
- Documented trauma history
- Acute symptoms such as pain on biting or mobility
- Radiographic evidence of fracture
Code-Specific Risks
- Missing the seventh character for encounter type
- Incorrectly using for non-traumatic cracks
Coding Notes
- Ensure to document the cause, location, and encounter type.
K03.81 - Cracked tooth (non-traumatic)
Use for non-traumatic cracks in teeth.
Applicable To
- Non-traumatic tooth cracks
Excludes
- Traumatic tooth fracture (S02.5)
Clinical Validation Requirements
- Absence of trauma
- Evidence of predisposing factors like bruxism or large restorations
Coding Notes
Document the absence of trauma and presence of other factors.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Fall on same level from slipping, tripping and stumbling
W10.8XXADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fractured Tooth to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S02.5XXA.
Impact
Clinical: Leads to vague clinical documentation., Regulatory: Non-compliance with ICD-10 specificity requirements., Financial: Potential for claim denials.
Mitigation Strategy
Always use the most specific code available., Ensure documentation supports the chosen code.
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use K03.81 for non-traumatic cracks.
Impact
Reimbursement: Claims may be denied for incomplete coding., Compliance: Fails to meet ICD-10 coding standards., Data Quality: Incomplete encounter information.
Mitigation Strategy
Always include the appropriate seventh character (e.g., A for initial encounter).
Impact
Using unspecified codes or missing encounter details.
Mitigation Strategy
Ensure complete documentation and use of specific codes.
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 Fractured Tooth, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fractured Tooth
Use these documentation templates to ensure complete and accurate documentation for Fractured Tooth. These templates include all required elements for proper coding and billing.
Traumatic Tooth Fracture
Specialty: Emergency MedicineRequired Elements
- History of trauma
- Clinical examination findings
- Radiographic evidence
- Treatment provided
- Follow-up plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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