ICD-10 Coding for Fracture of Tooth(S02.51XA, S02.52XD)
Complete ICD-10-CM coding and documentation guide for Fracture of Tooth. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fracture of 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 |
|---|---|---|---|
| S02.51XA | Fracture of crown of tooth, initial encounter | Use for initial encounters of crown fractures due to trauma. |
|
| S02.52XD | Fracture of root of tooth, subsequent encounter | Use for subsequent encounters of root 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 tooth fracture
Essential facts and insights about Fracture of Tooth
Primary ICD-10-CM Codes for fracture of tooth
Decision Criteria
clinical Criteria
- Presence of a visible fracture line on clinical exam
coding Criteria
- Initial encounter for traumatic fracture
Applicable To
- Visible enamel/dentin fracture line on clinical exam
Excludes
- Cracked tooth (K03.81)
Clinical Validation Requirements
- Fracture line visible under 16x magnification
- Explorer catches at fracture site
- CBCT confirms fracture
Code-Specific Risks
- Incorrectly using for non-traumatic cracks
- Missing the seventh character
Coding Notes
- Ensure to document the type of encounter and laterality.
S02.52XD - Fracture of root of tooth, subsequent encounter
Use for subsequent encounters of root fractures.
Applicable To
- Vertical root fracture
Excludes
- Cracked tooth (K03.81)
Clinical Validation Requirements
- CBCT slice confirms fracture extending from CEJ to apex
- Surgical visualization of fracture
Coding Notes
Ensure to document the type of encounter and laterality.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Dislocation of tooth, initial encounter
S03.01XADifferential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Cracked tooth
K03.81Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fracture of Tooth to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S02.51XA.
Impact
Clinical: Ambiguity in treatment records., Regulatory: Potential for audit issues., Financial: Claim denials or delays.
Mitigation Strategy
Always specify tooth number or side., Use templates that prompt for laterality.
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate patient records and statistics.
Mitigation Strategy
Use K03.81 for non-traumatic cracked teeth.
Impact
Reimbursement: Claims may be denied or delayed., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate encounter data.
Mitigation Strategy
Ensure to include the appropriate seventh character for encounter type.
Impact
Failure to include the seventh character can lead to audits.
Mitigation Strategy
Implement checks to ensure all codes have the correct seventh character.
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 Fracture of Tooth, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fracture of Tooth
Use these documentation templates to ensure complete and accurate documentation for Fracture of Tooth. These templates include all required elements for proper coding and billing.
Endodontic Progress Note
Specialty: EndodonticsRequired Elements
- Clinical Findings
- Imaging
- Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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