S02.85XA: Fracture of orbit, unspecified, initial encounter for closed fracture
S02.85XA is a billable, specific ICD-10-CM code for fracture of orbit, unspecified, initial encounter for closed fracture. It is valid for submission on a claim.
Check S02.85XA with the rest of the claim: free scrubber7th 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
Excludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Fracture of orbit NOS
- Fracture of orbit wall NOS
Excludes1 inherited from the categories above S02.85XA
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above S02.85XA
Not part of this code, but both may be coded when both are present.
Other codes that can never be billed with S02.85XA
Their own Excludes1 notes name this code, so the conflict is not listed above.
- S01Open wound of head
Risk adjustment
S02.85XA 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
S02.85XA is named in 2 Medicare coverage policies: 2 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
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S02.85
- S02.85XBFracture of orbit, unspecified, initial encounter for open fracture
- S02.85XDFracture of orbit, unspecified, subsequent encounter for fracture with routine healing
- S02.85XGFracture of orbit, unspecified, subsequent encounter for fracture with delayed healing
- S02.85XKFracture of orbit, unspecified, subsequent encounter for fracture with nonunion
- S02.85XSFracture of orbit, unspecified, sequela