ICD-10 Coding for Broken Tooth(S02.5XXA, S02.5XXB)
Complete ICD-10-CM coding and documentation guide for Broken Tooth. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Broken 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 (traumatic), initial encounter | Use for initial encounters of traumatic tooth fractures. |
|
| S02.5XXB | Fracture of tooth (traumatic), initial encounter, open | Use for initial encounters of open traumatic tooth fractures. |
|
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 broken tooth
Essential facts and insights about Broken Tooth
Primary ICD-10-CM Codes for broken tooth
Decision Criteria
clinical Criteria
- Presence of a traumatic event leading to the fracture
Applicable To
- Initial encounter for closed traumatic fracture
Excludes
- Cracked tooth syndrome (K03.81)
Clinical Validation Requirements
- Radiographic evidence of fracture
- Clinical examination showing fracture line
Code-Specific Risks
- Incorrect 7th character usage
- Confusion with non-traumatic conditions
Coding Notes
- Ensure trauma mechanism is documented.
S02.5XXB - Fracture of tooth (traumatic), initial encounter, open
Use for initial encounters of open traumatic tooth fractures.
Applicable To
- Initial encounter for open traumatic fracture
Excludes
- Cracked tooth syndrome (K03.81)
Clinical Validation Requirements
- Visible pulp exposure
- Fracture communicates with oral cavity
Coding Notes
Ensure open fracture details are documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Cracked tooth syndrome
K03.81Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Broken 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: Inadequate clinical record, Regulatory: Non-compliance with documentation standards, Financial: Potential claim denial
Mitigation Strategy
Always include tooth number in notes, Use templates to ensure completeness
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Document parafunctional habits to support K03.81.
Impact
Lack of detailed trauma documentation can lead to audit issues.
Mitigation Strategy
Ensure all trauma details are documented in the patient's history.
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 Broken Tooth, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Broken Tooth
Use these documentation templates to ensure complete and accurate documentation for Broken Tooth. These templates include all required elements for proper coding and billing.
Initial encounter for traumatic tooth fracture
Specialty: General DentistryRequired Elements
- Trauma mechanism
- Tooth number
- Fracture type
- Radiographic evidence
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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