S22.042B: Unstable burst fracture of fourth thoracic vertebra, initial encounter for open fracture
S22.042B is a billable, specific ICD-10-CM code for unstable burst fracture of fourth thoracic vertebra, initial encounter for open fracture. It is valid for submission on a claim.
Check S22.042B with the rest of the claim: free scrubber7th character "B": initial encounter for open fracture
The appropriate 7th character is to be added to each code from category S22
- 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 inherited from the categories above S22.042B
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above S22.042B
Not part of this code, but both may be coded when both are present.
Other codes that can never be billed with S22.042B
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
S22.042B risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 401 Vertebral Fractures without Spinal Cord Injury0.522 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
S22.042B is named in 9 Medicare coverage policies: 9 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A54767Billing and Coding: Medicare Preventive Coverage for Certain Vaccines
- A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
- A56900Billing and Coding: Immunizations
- A57132Billing and Coding: Bone Mass Measurement
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under S22.042
- S22.042AUnstable burst fracture of fourth thoracic vertebra, initial encounter for closed fracture
- S22.042DUnstable burst fracture of fourth thoracic vertebra, subsequent encounter for fracture with routine healing
- S22.042GUnstable burst fracture of fourth thoracic vertebra, subsequent encounter for fracture with delayed healing
- S22.042KUnstable burst fracture of fourth thoracic vertebra, subsequent encounter for fracture with nonunion
- S22.042SUnstable burst fracture of fourth thoracic vertebra, sequela