ED Coding and Reimbursement Alert

Question: When coding multiple specified fractures on the same orbit, should we you use one code or code each specific fracture on the same orbit?

Answer: The answer will depend on how the physician documents the fractures in the record. ICD-10-CM Official Guidelines indicate, “Multiple fractures are sequenced in accordance with the severity of the fracture.”

If the physician has just evaluated the patient for the fractures to make sure no surgery is indicated, the most severe fracture would be sequenced first, with the remaining fractures coded in hierarchical order.

For instance, if a patient presented to the ED with a severe fracture of the medial orbital wall of the right eye and a mild fracture of the lateral orbital wall of the right eye, then you would report the following diagnosis codes:

• S02.831A (Fracture of medial orbital wall, right side, initial encounter for closed fracture)
• S02.841A (Fracture of lateral orbital wall, right side, initial encounter for closed fracture)

The medial orbital wall fracture is listed first since the severity of that injury is greater than that of the lateral orbital wall.