ICD-10 Coding for Fracture of Toe(S92.401A, S92.515A)
Complete ICD-10-CM coding and documentation guide for Fracture of Toe. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fracture of Toe
S92.4-S92.5Primary Range
Fracture of toe bones
This range includes codes for fractures of the great toe and lesser toes, specifying laterality and encounter type.
Open wound of toe with nail damage
Used when there is an open wound associated with the toe 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 |
|---|---|---|---|
| S92.401A | Displaced fracture of proximal phalanx of right great toe, initial encounter | Use for initial encounters with displaced fractures of the right great toe. |
|
| S92.515A | Displaced fracture of proximal phalanx of right lesser toe(s), initial encounter | Use for initial encounters with displaced fractures of the right lesser toes. |
|
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 toe fracture
Essential facts and insights about Fracture of Toe
Primary ICD-10-CM Codes for fracture toe
Decision Criteria
clinical Criteria
- Presence of a displaced fracture confirmed by imaging.
Applicable To
- Displaced fracture of right great toe
Excludes
- Open fracture of right great toe
Clinical Validation Requirements
- X-ray confirmation of fracture
- Physical exam findings of displacement
Code-Specific Risks
- Ensure laterality and displacement are documented.
Coding Notes
- Ensure to document the encounter type and laterality.
S92.515A - Displaced fracture of proximal phalanx of right lesser toe(s), initial encounter
Use for initial encounters with displaced fractures of the right lesser toes.
Applicable To
- Displaced fracture of right lesser toes
Excludes
- Open fracture of right lesser toes
Clinical Validation Requirements
- X-ray confirmation of fracture
- Physical exam findings of displacement
Coding Notes
Ensure to document the encounter type and laterality.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fracture of Toe to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S92.401A.
Impact
Clinical: May affect treatment decisions., Regulatory: Non-compliance with coding guidelines., Financial: Potential for denied claims.
Mitigation Strategy
Always document displacement in the clinical notes.
Impact
Reimbursement: May lead to reduced reimbursement., Compliance: Increases risk of audit failures., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Always document and code the specific toe and type of fracture.
Impact
Using unspecified codes increases audit risk.
Mitigation Strategy
Ensure documentation is detailed and specific.
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 Toe, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fracture of Toe
Use these documentation templates to ensure complete and accurate documentation for Fracture of Toe. These templates include all required elements for proper coding and billing.
Initial encounter for displaced toe fracture
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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