S02.42XA — Fracture of alveolus of maxilla, initial encounter for closed fracture
S02.42XA is a billable, specific ICD-10-CM code for fracture of alveolus of maxilla, initial encounter for closed fracture. It is valid for submission on a claim.
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
Risk adjustment
S02.42XA 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.
Medicare coverage
S02.42XA is named in 3 Medicare coverage policies — 3 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A56612Billing and Coding: CT of the Head
- A57068Billing and Coding: Ocular Photography - External
- A57204Billing and Coding: MRI and CT Scans of the Head and Neck
Related codes at this level
Codes that share S02.42. If S02.42XA is not quite right, the correct code is usually one of these.
- S02.42XBFracture of alveolus of maxilla, initial encounter for open fracture
- S02.42XDFracture of alveolus of maxilla, subsequent encounter for fracture with routine healing
- S02.42XGFracture of alveolus of maxilla, subsequent encounter for fracture with delayed healing
- S02.42XKFracture of alveolus of maxilla, subsequent encounter for fracture with nonunion
- S02.42XSFracture of alveolus of maxilla, sequela
Questions about S02.42XA
- Is S02.42XA a billable ICD-10-CM code?
- Yes. S02.42XA is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does S02.42XA sit in the tabular list?
- Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the head (S00-S09).