S02.40BA

S02.40BA: Malar fracture, left side, initial encounter for closed fracture

Billable / specific codeICD-10-CMleft

S02.40BA is a billable, specific ICD-10-CM code for malar fracture, left side, initial encounter for closed fracture. It is valid for submission on a claim.

Check S02.40BA with the rest of the claim: free scrubber

7th character "A": initial encounter for closed 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 S02.40BA

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

S01Open wound of head

Risk adjustment

S02.40BA 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

S02.40BA is named in 3 Medicare coverage policies: 3 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A56612Billing and Coding: CT of the Head
A56729Billing and Coding: Magnetic Resonance Imaging of the Head and Neck
A57204Billing and Coding: MRI and CT Scans of the Head and Neck

Code history

Unchanged in every release from FY2024 to FY2027.