S02.85XB — Fracture of orbit, unspecified, initial encounter for open fracture
S02.85XB is a billable, specific ICD-10-CM code for fracture of orbit, unspecified, initial encounter for open fracture. It is valid for submission on a claim.
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
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 S02.85XB
These are not written on S02.85XB, but they bind it: a note on a category applies to every code beneath it. Billing S02.85XB with anything listed here is a denial.
Excludes2 inherited from the categories above S02.85XB
Also inherited, and the opposite of Excludes1: these conditions are not part of S02.85XB, but a patient can have both, so you may code both.
Other codes that can never be billed with S02.85XB
These codes carry an Excludes1 note pointing at S02.85XB. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading S02.85XB alone.
- S01Open wound of head
Risk adjustment
S02.85XB 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
S02.85XB 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.
- A54767Billing and Coding: Medicare Preventive Coverage for Certain Vaccines
- A56612Billing and Coding: CT of the Head
- A56729Billing and Coding: Magnetic Resonance Imaging of the Head and Neck
Code history
S02.85XB has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
Related codes at this level
Codes that share S02.85. If S02.85XB is not quite right, the correct code is usually one of these.
- S02.85XAFracture of orbit, unspecified, initial encounter for closed 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
Questions about S02.85XB
- Is S02.85XB a billable ICD-10-CM code?
- Yes. S02.85XB is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does S02.85XB 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).
- What cannot be coded together with S02.85XB?
- S02.85XB carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above S02.85XB (S02.85) and apply to it just the same.