Beginning Oct. 1, 2016, the U.S. health care system will adopt numerous new or revised ICD-10 codes – including nearly 400 changes affecting ophthalmologists. This guide will show you how to correctly code orbital-floor fractures for dates of service beginning Oct. 1. Topic covered include the seventh character position status pertaining to fractures, a facial-fractures overview and their inclusion of laterality.
New Laterality Requirement for S02 Fracture Family
Starting Oct. 1, a change applies to coding orbital floor fractures: S02 Fracture of skull and facial bones.
- Code length: Seven characters (no change)
- Old requirement (dates of service Oct. 1, 2015 to Sept. 30, 2016): The X placeholder was required in two positions, both the fifth and sixth character. Basic structure: S02.3XXA.
- S02 - First three characters represent fracture family
- 3 in the fourth position represents orbital floor
- XX in the fifth and sixth position represent placeholders
- A in the seventh position represents the status
- New requirement (dates of service beginning Oct. 1, 2016): Define laterality in the fifth position. Continue to put the placeholder X in the sixth position. Revised structure: S02.3_X-.
- Same: S02. Is the fracture of skull and facial bones.
- Same: 3 in the fourth position represents orbital floor
- New: Fifth position shows laterality
- 1-Right eye
- 2- Left eye
- 3- Bilateral
- Seventh position represents the status
- Same: Seventh character shows the fracture status, based on six options
Fracture Status Options
For a first encounter, surgical intervention or a new physician visit, choose the appropriate initial-encounter status. For postoperative care and follow-up examinations, choose based on the status of healing.
You won’t use S as the seventh final character very often. When used, it will be secondary to the new condition that affects the patient. While a valid code, payers may not recognize or even require its use for payment.
||Initial encounter for closed fracture
||Initial encounter for open fracture
||Subsequent encounter for fracture with routine healing
||Subsequent encounter for fracture with delayed healing
||Subsequent encounter for fracture with nonunion
Orbital Floor Fracture Examples
In the first case, a patient is seen following a fall and hitting his left eye on the ground.
- Diagnosis: After examination, the surgeon determines the patient has a closed orbital floor fracture.
- Submit: S02.32XA
- S02.3 indicates orbital floor fracture
- 2 in the fifth position represents the left eye
- X placeholder is in the sixth position
- Seventh final character is A for initial encounter for a closed fracture
In the second case, Mrs. Smith presents for a follow-up exam after surgical intervention on her right eye.
- Diagnosis: The surgeon determines she is not healing well and needs to be closely monitored.
- Submit: S02.31XG
- S02.3 again indicates orbital floor fracture
- 1 in the fifth position is for the right eye
- X placeholder is in the 6th position
- Seventh final character is G for subsequent encounter for fracture with delayed healing.
New, Alphabetical, Laterality Requirement for S02.40 Fracture Family
Orbital floor fracture codes are not the only fracture codes to add laterality. The family S02.40 fracture of malar, maxillary and zygomatic bones now require laterality in the sixth position. However, you indicate laterality alphabetically, not numerically. The new codes are as follows:
- Same: S02.40 is the chapter header
- New: Sixth position shows laterality
- A in the 6th position indicates Malar fracture, right side;
- B for the left side
- C in the 6th position indicates Maxillary fracture, right side;
- D for the left side
- E in the 6th position indicates Zygomatic fracture, right side;
- F for the left side.
- Same: Seventh character shows the fracture status, based on the six options detailed above.
How to Ensure Your Practice Implements These New Codes Effectively
In addition to learning the new codes, follow these best practices for effective implementation.
- Be sure to update all practice management systems, superbills and electronic health record systems to remove outdated codes; whether you strikethrough, grey them out or remove them all together.
- Educate all those who will be doing data entry.
- Ensure all physicians, coders and technicians also know of and understand the changes.
Tutorial (Recorded Sept. 2016)
Quick Reference Guides and Decision Trees
To help you successfully adopt the code revisions, the Academy has developed several quick reference guides and decision trees, available at www.aao.org/icd10. You can print these out and place them in the lanes or wherever your staff performs data entry.
For in-depth guidance, make sure all staff affected have the Academy’s 2017 ICD-10-CM for Ophthalmology, the complete reference. This is available both print and online. For questions pertaining to ICD-10 billing, email ICD10@aao.org.