S02.113B: Unspecified occipital condyle fracture, initial encounter for open fracture
S02.113B is a billable, specific ICD-10-CM code for unspecified occipital condyle fracture, initial encounter for open fracture. It is valid for submission on a claim.
Check S02.113B with the rest of the claim: free scrubber7th character "B": initial encounter for open fracture
The appropriate 7th character is to be added to each code from category S02
- A
- initial encounter for closed fracture
- B
- initial encounter for open fracture
- D
- subsequent encounter for fracture with routine healing
- G
- subsequent encounter for fracture with delayed healing
- K
- subsequent encounter for fracture with nonunion
- S
- sequela
Other codes that can never be billed with S02.113B
Their own Excludes1 notes name this code, so the conflict is not listed above.
- S01Open wound of head
Risk adjustment
S02.113B risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 399 Major Head Injury without Loss of Consciousness0.199 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
S02.113B is named in 1 Medicare coverage policy: 1 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A56612Billing and Coding: CT of the Head
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S02.113
- S02.113AUnspecified occipital condyle fracture, initial encounter for closed fracture
- S02.113DUnspecified occipital condyle fracture, subsequent encounter for fracture with routine healing
- S02.113GUnspecified occipital condyle fracture, subsequent encounter for fracture with delayed healing
- S02.113KUnspecified occipital condyle fracture, subsequent encounter for fracture with nonunion
- S02.113SUnspecified occipital condyle fracture, sequela