Q&A: Specificity required for reporting of an orbital fracture in ICD-10-CM

Q: Would it be appropriate to query the provider for clarification if documentation for an orbital fracture doesn’t specify the location of the fracture and whether it is open or closed?

A: Effective October 1, coders may report several new ICD-10-CM codes for orbital fractures. As part of the fiscal year (FY) 2020 update to the ICD-10-CM code set, the following code subcategories were added for orbital fractures:

• S02.12-, fracture of orbital roof
• S02.83-, fracture of medial orbital wall
• S02.84-, fracture of lateral orbital wall

These ICD-10-CM subcategories specify whether the fracture is located on the orbital roof, or the medial or lateral wall. If the fracture is described as affecting a specific location or part of the eye but doesn’t explicitly state the name of the location, it may be appropriate to request additional details. If little to no information is provided about the injury, the coder may report an ICD-10-CM code from the new FY 2020 subcategory S02.85- (fracture of orbit, unspecified).

However, coders shouldn’t query solely for clarification on whether the fracture is open or closed. There is a note under code category S02.- (fracture of skull and facial bones) that instructs coders to default to a closed fracture if the documentation doesn’t specify whether it is open or closed.

Editor’s note: Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, HCS-D, director of HIM and coding for HCPro in Middleton, Massachusetts, answered this question during the HCPro webinar, JustCoding's 2020 ICD-10-CM Code Updates.

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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