ICD-10 Coding for Fractured Teeth(S02.5XXA, K03.81)
Complete ICD-10-CM coding and documentation guide for Fractured Teeth. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Fractured Teeth
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 for closed fracture | Use for initial encounter of a traumatic tooth fracture. |
|
| K03.81 | Cracked tooth (non-traumatic) | Use for non-traumatic cracks detected during routine exams. |
|
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: How to code a tooth fractured during eating?
Essential facts and insights about Fractured Teeth
Primary ICD-10-CM Codes for fractured teeth
Decision Criteria
clinical Criteria
- Presence of a traumatic event leading to tooth fracture.
documentation Criteria
- Radiographic evidence and clinical notes confirming fracture.
Applicable To
- Traumatic fracture of tooth
Excludes
- Non-traumatic cracks (K03.81)
Clinical Validation Requirements
- Radiographic confirmation of fracture line
- Documentation of traumatic event
Code-Specific Risks
- Incorrect seventh character usage
- Lack of trauma documentation
Coding Notes
- Ensure documentation specifies the traumatic cause and fracture type.
K03.81 - Cracked tooth (non-traumatic)
Use for non-traumatic cracks detected during routine exams.
Applicable To
- Non-traumatic cracks in teeth
Excludes
- Traumatic fractures (S02.5XXA)
Clinical Validation Requirements
- Absence of trauma history
- Microscopic or imaging evidence of crack
Coding Notes
Ensure documentation specifies absence of trauma.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Pulpitis
K04.0Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Fractured Teeth to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S02.5XXA.
Impact
Clinical: Misrepresentation of clinical scenario., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always document the traumatic event., Use radiographic evidence to support claims.
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use K03.81 for non-traumatic cracks.
Impact
Lack of detailed trauma documentation can lead to audit issues.
Mitigation Strategy
Ensure comprehensive documentation of the traumatic event.
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 Fractured Teeth, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Fractured Teeth
Use these documentation templates to ensure complete and accurate documentation for Fractured Teeth. These templates include all required elements for proper coding and billing.
Traumatic Tooth Fracture
Specialty: DentistryRequired Elements
- Patient's account of trauma
- Radiographic findings
- Clinical examination details
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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