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ICD-10 Guide
ICD-10 CodesS22.049

S22.049

Billable

Unspecified fracture of fourth thoracic vertebra

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

Code Description

ICD-10 S22.049 is a billable code used to indicate a diagnosis of unspecified fracture of fourth thoracic vertebra.

Key Diagnostic Point:

An unspecified fracture of the fourth thoracic vertebra (T4) typically occurs due to trauma, such as falls, motor vehicle accidents, or sports injuries. This type of fracture can lead to significant complications, including spinal instability, neurological deficits, and potential damage to surrounding structures. The thoracic spine is critical for protecting the spinal cord and supporting the rib cage, which houses vital organs such as the heart and lungs. Fractures in this area may also be associated with rib fractures, pneumothorax, or hemothorax, which can complicate the clinical picture. Patients may present with back pain, difficulty breathing, or neurological symptoms depending on the severity of the injury. Diagnosis is usually confirmed through imaging studies such as X-rays, CT scans, or MRIs. Treatment may involve conservative management with pain control and physical therapy or surgical intervention if there is significant instability or neurological compromise. Accurate coding is essential for appropriate reimbursement and to reflect the severity of the injury in clinical documentation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of fractures
  • Need for precise documentation of associated injuries
  • Differentiation from other thoracic vertebra fractures
  • Potential for complications such as pneumothorax or hemothorax

Audit Risk Factors

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

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on fracture type, location, and treatment plan.

Common Clinical Scenarios

Fractures due to falls, sports injuries, or trauma.

Billing Considerations

Ensure clarity on whether the fracture is stable or unstable.

Emergency Medicine

Documentation Requirements

Comprehensive assessment of trauma, including imaging results.

Common Clinical Scenarios

Patients presenting with acute back pain after trauma.

Billing Considerations

Document any immediate interventions and patient stability.

Coding Guidelines

Inclusion Criteria

Use S22.049 When
  • Follow ICD
  • CM guidelines for coding fractures, including specificity regarding the location and type of fracture
  • Ensure to document any associated injuries or complications

Exclusion Criteria

Do NOT use S22.049 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22551CPT Code

Percutaneous vertebroplasty

Clinical Scenario

Used for stabilization of vertebral fractures.

Documentation Requirements

Document indication for procedure and imaging findings.

Specialty Considerations

Orthopedic specialists should ensure clear documentation of fracture type.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of clinical data and reimbursement processes. S22.049 reflects the need for specificity in documenting thoracic injuries.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of clinical data and reimbursement processes. S22.049 reflects the need for specificity in documenting thoracic injuries.

Reimbursement & Billing Impact

reimbursement processes. S22.049 reflects the need for specificity in documenting thoracic injuries.

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 S22.049 accurately?

Accurate coding of S22.049 is crucial for proper reimbursement, reflecting the severity of the injury, and ensuring appropriate treatment plans are followed. It also aids in tracking injury patterns and outcomes in clinical settings.