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ICD-10 Guide
ICD-10 CodesS22.019

S22.019

Billable

Unspecified fracture of first thoracic vertebra

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/23/2025

Code Description

ICD-10 S22.019 is a billable code used to indicate a diagnosis of unspecified fracture of first thoracic vertebra.

Key Diagnostic Point:

The unspecified fracture of the first thoracic vertebra (T1) is a significant injury that can occur due to various mechanisms of trauma, including falls, motor vehicle accidents, or sports injuries. The thoracic spine is crucial for providing structural support to the upper body and protecting the spinal cord. An injury to the T1 vertebra can lead to a range of complications, including pain, limited mobility, and potential neurological deficits if the spinal cord is affected. Patients may present with symptoms such as localized back pain, tenderness, and muscle spasms. Diagnostic imaging, typically X-rays or MRI, is essential for confirming the fracture and assessing any associated injuries, such as rib fractures, pneumothorax, or hemothorax. Given the proximity of the thoracic vertebrae to vital organs, careful evaluation for cardiac injuries is also warranted. Treatment may involve conservative management with pain control and physical therapy or surgical intervention in more severe cases. Accurate coding is essential for proper reimbursement and tracking of patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of thoracic spine injuries
  • Need for precise documentation of associated injuries
  • Differentiation from other thoracic vertebra fractures
  • Potential for neurological involvement requiring additional codes

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to document associated injuries (e.g., pneumothorax, rib fractures)
  • Misclassification of fracture type
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, surgical notes, and follow-up assessments are necessary to support the diagnosis and treatment plan.

Common Clinical Scenarios

Fractures resulting from falls, sports injuries, or motor vehicle accidents.

Billing Considerations

Documentation must clearly indicate the type of fracture and any associated injuries to ensure accurate coding.

Emergency Medicine

Documentation Requirements

Comprehensive documentation of the patient's presentation, mechanism of injury, and initial management.

Common Clinical Scenarios

Patients presenting with acute back pain following trauma, often requiring imaging and stabilization.

Billing Considerations

Timely documentation is critical for coding and billing, especially in acute care settings.

Coding Guidelines

Inclusion Criteria

Use S22.019 When
  • According to ICD
  • 10 guidelines, S22
  • 019 should be used when the fracture is confirmed but not specified further
  • It is important to document the mechanism of injury and any associated conditions to support the use of this code

Exclusion Criteria

Do NOT use S22.019 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22551CPT Code

Percutaneous vertebroplasty

Clinical Scenario

Used in cases of vertebral fractures requiring stabilization.

Documentation Requirements

Pre-operative imaging and surgical notes must be documented.

Specialty Considerations

Orthopedic specialists should ensure accurate coding based on the type of fracture.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more detailed coding of fractures, improving the specificity of patient records and enhancing the ability to track outcomes and complications.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more detailed coding of fractures, improving the specificity of patient records and enhancing the ability to track outcomes and complications.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more detailed coding of fractures, improving the specificity of patient records and enhancing the ability to track outcomes and complications.

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 significance of coding S22.019?

Coding S22.019 accurately reflects the patient's injury and is crucial for appropriate treatment planning, reimbursement, and tracking of outcomes.