S02.121B

S02.121B: Fracture of orbital roof, right side, initial encounter for open fracture

Billable / specific codeICD-10-CMright

S02.121B is a billable, specific ICD-10-CM code for fracture of orbital roof, right side, initial encounter for open fracture. It is valid for submission on a claim.

Check S02.121B with the rest of the claim: free scrubber

7th 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

Excludes2 inherited from the categories above S02.121B

Not part of this code, but both may be coded when both are present.

Written on S02.1: Fracture of base of skull

lateral orbital wall (S02.84-)
medial orbital wall (S02.83-)
orbital floor (S02.3-)

Other codes that can never be billed with S02.121B

Their own Excludes1 notes name this code, so the conflict is not listed above.

S01Open wound of head

Risk adjustment

S02.121B 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

S02.121B is named in 9 Medicare coverage policies: 9 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A53057Billing and Coding: Home Health Occupational Therapy
A53058Billing and Coding: Home Health Physical Therapy
A53064Billing and Coding: Outpatient Occupational Therapy
A53065Billing and Coding: Outpatient Physical Therapy

Code history

Unchanged in every release from FY2024 to FY2027.