ICD-10 Coding for Tooth Fracture(S02.5XXA, S02.5XXD)
Complete ICD-10-CM coding and documentation guide for Tooth Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Tooth Fracture
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 (traumatic), initial encounter | Use for initial encounters where active treatment is provided for a traumatic tooth fracture. |
|
| S02.5XXD | Fracture of tooth (traumatic), subsequent encounter | Use for subsequent encounters during the healing phase of a traumatic tooth fracture. |
|
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 tooth fracture
Essential facts and insights about Tooth Fracture
Primary ICD-10-CM Codes for tooth fracture
Decision Criteria
clinical Criteria
- Presence of a traumatic event leading to tooth fracture
coding Criteria
- Use 7th character 'A' for initial encounter
S02.5XXD - Fracture of tooth (traumatic), subsequent encounter
Use for subsequent encounters during the healing phase of a traumatic tooth fracture.
Applicable To
- Follow-up for tooth fracture
Excludes
- Initial encounter (S02.5XXA)
Clinical Validation Requirements
- Documented healing process
- Follow-up visit notes
Coding Notes
Ensure the 7th character reflects the encounter type.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
CBCT for fracture extent evaluation
D0364Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Tooth Fracture 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 inadequate treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Use detailed templates for documentation., Include imaging results and clinical findings.
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Ensure the 7th character reflects the encounter type (A for initial, D for subsequent).
Impact
Lack of detailed trauma documentation can lead to audit issues.
Mitigation Strategy
Ensure all trauma details are documented, including mechanism and clinical findings.
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 Tooth Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Tooth Fracture
Use these documentation templates to ensure complete and accurate documentation for Tooth Fracture. These templates include all required elements for proper coding and billing.
Emergency Department Visit for Tooth Fracture
Specialty: Emergency MedicineRequired Elements
- Mechanism of injury
- Fracture classification
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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