S02.5XXG

S02.5XXG: Fracture of tooth (traumatic), subsequent encounter for fracture with delayed healing

Billable / specific codeICD-10-CMPOA exempt

S02.5XXG is a billable, specific ICD-10-CM code for fracture of tooth (traumatic), subsequent encounter for fracture with delayed healing. It is valid for submission on a claim.

Check S02.5XXG with the rest of the claim: free scrubber

7th character "G": subsequent encounter for fracture with delayed healing

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

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

cracked tooth (nontraumatic) (K03.81)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Broken tooth

Excludes1 inherited from the categories above S02.5XXG

A category’s note binds every code beneath it.

Written on S02.5: Fracture of tooth (traumatic)

cracked tooth (nontraumatic) (K03.81)

Other codes that can never be billed with S02.5XXG

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

S01Open wound of head

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

S02.5XXG is named in 3 Medicare coverage policies: 3 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A53065Billing and Coding: Outpatient Physical Therapy
A56658Billing and Coding: Cosmetic and Reconstructive Surgery
A57204Billing and Coding: MRI and CT Scans of the Head and Neck

Code history

Unchanged in every release from FY2024 to FY2027.