ICD-10 Coding for Toe Fracture(S92.401A, S92.402A)
Complete ICD-10-CM coding and documentation guide for Toe Fracture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Toe Fracture
S92.4-S92.5Primary Range
Fracture of toe, including great toe and lesser toes
This range includes codes for fractures of the great toe and lesser toes, which are the primary focus for toe fractures.
Open wound of toe with nail damage
Used when there is an open wound associated with the toe fracture, particularly involving the nail.
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 | Fracture of right great toe, initial encounter | Use for initial encounter of a right great toe fracture, whether displaced or non-displaced. |
|
| S92.402A | Fracture of left great toe, initial encounter | Use for initial encounter of a left great toe fracture, whether displaced or non-displaced. |
|
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 Toe Fracture
Primary ICD-10-CM Codes for toe fracture
Decision Criteria
clinical Criteria
- Presence of fracture confirmed by imaging
documentation Criteria
- Detailed notes on fracture location and type
Applicable To
- Displaced fracture of right great toe
- Non-displaced fracture of right great toe
Excludes
- Fracture of lesser toes
- Open wound without fracture
Clinical Validation Requirements
- X-ray confirmation of fracture
- Clinical notes detailing fracture type and location
Code-Specific Risks
- Misclassification if laterality is not specified
- Incorrect use if fracture type is not documented
Coding Notes
- Ensure laterality and fracture type are clearly documented.
S92.402A - Fracture of left great toe, initial encounter
Use for initial encounter of a left great toe fracture, whether displaced or non-displaced.
Applicable To
- Displaced fracture of left great toe
- Non-displaced fracture of left great toe
Excludes
- Fracture of lesser toes
- Open wound without fracture
Clinical Validation Requirements
- X-ray confirmation of fracture
- Clinical notes detailing fracture type and location
Coding Notes
Ensure laterality and fracture type are clearly 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.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Toe Fracture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S92.401A.
Impact
Clinical: Inaccurate treatment planning., Regulatory: Potential audit issues., Financial: Incorrect billing and potential claim denials.
Mitigation Strategy
Always document fracture type in clinical notes., Cross-check with imaging reports.
Impact
Reimbursement: Claims may be denied or delayed due to incorrect coding., Compliance: Non-compliance with coding standards., Data Quality: Inaccurate patient records and statistics.
Mitigation Strategy
Verify and document the correct side of the body for the fracture.
Impact
Failure to specify open vs closed fractures can lead to audit flags.
Mitigation Strategy
Ensure all documentation specifies fracture type and matches imaging findings.
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 Toe Fracture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Toe Fracture
Use these documentation templates to ensure complete and accurate documentation for Toe Fracture. These templates include all required elements for proper coding and billing.
Initial assessment of toe fracture
Specialty: OrthopedicsRequired Elements
- Patient history
- Mechanism of injury
- Physical examination findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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