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ICD-10 Guide
ICD-10 CodesS02.42

S02.42

Billable

Fracture of alveolus of maxilla

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 S02.42 is a billable code used to indicate a diagnosis of fracture of alveolus of maxilla.

Key Diagnostic Point:

The fracture of the alveolus of the maxilla refers to a break in the bony ridge of the upper jaw where the teeth are anchored. This type of fracture can occur due to various mechanisms, including trauma from falls, sports injuries, or vehicular accidents. Clinically, patients may present with pain, swelling, and possible displacement of teeth in the affected area. Diagnosis typically involves a thorough clinical examination and imaging studies such as X-rays or CT scans to assess the extent of the fracture and any associated injuries. Management may include pain control, stabilization of the fracture, and in some cases, surgical intervention to realign the bone and secure it with plates or screws. Complications can include malocclusion, infection, and delayed healing. Accurate coding is essential for proper reimbursement and tracking of treatment outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of fractures
  • Need for imaging studies to confirm diagnosis
  • Potential for associated dental injuries
  • Documentation of mechanism of injury

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the type of fracture
  • Misclassification of the fracture site
  • Lack of imaging documentation

Specialty Focus

Medical Specialties

Emergency Medicine

Documentation Requirements

Documentation should include a detailed account of the injury mechanism, initial assessment findings, and any imaging results.

Common Clinical Scenarios

Patients presenting with facial trauma from accidents or sports injuries.

Billing Considerations

Ensure that all relevant injuries are documented to support the coding of S02.42.

Surgery

Documentation Requirements

Operative reports must detail the surgical approach, fixation methods, and any complications encountered.

Common Clinical Scenarios

Surgical repair of maxillary fractures following trauma.

Billing Considerations

Document any pre-existing conditions that may affect healing or surgical outcomes.

Coding Guidelines

Inclusion Criteria

Use S02.42 When
  • Follow the ICD
  • CM guidelines for coding fractures, ensuring specificity in the location and type of fracture
  • Document the mechanism of injury and any associated conditions

Exclusion Criteria

Do NOT use S02.42 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

21110CPT Code

Repair of maxillary fracture

Clinical Scenario

Used when surgical intervention is required for fracture repair.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Ensure alignment with surgical coding guidelines.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding fractures, including those of the maxilla, which aids in better tracking of treatment outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding fractures, including those of the maxilla, which aids in better tracking of treatment outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding fractures, including those of the maxilla, which aids in better tracking of treatment outcomes and resource allocation.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the primary mechanism of injury for S02.42?

The primary mechanisms include trauma from falls, sports injuries, and vehicular accidents, which can lead to fractures of the maxillary alveolus.