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ICD-10 Guide
ICD-10 CodesS22.058

S22.058

Billable

Other fracture of T5-T6 vertebra

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

Code Description

ICD-10 S22.058 is a billable code used to indicate a diagnosis of other fracture of t5-t6 vertebra.

Key Diagnostic Point:

The S22.058 code represents an 'Other fracture of T5-T6 vertebra,' which refers to non-specific fractures occurring in the thoracic spine, particularly at the fifth and sixth thoracic vertebrae. These fractures can result from various mechanisms, including trauma from falls, motor vehicle accidents, or sports injuries. The thoracic spine is crucial for protecting the spinal cord and supporting the rib cage, and fractures in this area can lead to significant complications such as spinal cord injury, respiratory issues, and chronic pain. Patients may present with symptoms such as localized back pain, neurological deficits, or signs of chest trauma. The management of T5-T6 fractures often involves a multidisciplinary approach, including pain management, physical therapy, and in some cases, surgical intervention to stabilize the spine. Complications such as pneumothorax or hemothorax may arise due to associated rib fractures or direct trauma to the thoracic cavity, necessitating careful monitoring and potential thoracic surgical interventions. Accurate coding is essential for appropriate treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture types and severity
  • Potential for associated injuries (e.g., rib fractures, pneumothorax)
  • Need for detailed documentation of trauma mechanism
  • Differentiation from other thoracic spine fractures

Audit Risk Factors

  • Inadequate documentation of fracture type
  • Failure to document associated injuries
  • Misclassification of fracture severity
  • Lack of clarity in mechanism of injury

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed imaging reports, surgical notes, and follow-up assessments.

Common Clinical Scenarios

Fractures resulting from falls, sports injuries, or vehicular accidents.

Billing Considerations

Ensure documentation specifies fracture type and any associated injuries.

Emergency Medicine

Documentation Requirements

Comprehensive trauma assessments, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with acute chest pain and back pain after trauma.

Billing Considerations

Document all findings related to chest trauma and potential complications.

Coding Guidelines

Inclusion Criteria

Use S22.058 When
  • Follow official coding guidelines for trauma
  • related injuries, ensuring accurate documentation of the fracture type and any associated conditions
  • Include details about the mechanism of injury and any surgical interventions performed

Exclusion Criteria

Do NOT use S22.058 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 indications for procedure and imaging findings.

Specialty Considerations

Orthopedic or neurosurgical documentation may be required.

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 data collection and reimbursement processes. S22.058 provides a more detailed classification of thoracic vertebral fractures, which can enhance patient care and treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, improving the accuracy of data collection and reimbursement processes. S22.058 provides a more detailed classification of thoracic vertebral fractures, which can enhance patient care and treatment planning.

Reimbursement & Billing Impact

reimbursement processes. S22.058 provides a more detailed classification of thoracic vertebral fractures, which can enhance patient care and treatment planning.

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 are the common causes of T5-T6 fractures?

Common causes include falls, motor vehicle accidents, and sports injuries. Osteoporosis can also contribute to fractures in older adults.

How do I differentiate between T5 and T6 fractures?

Imaging studies such as X-rays or MRI can help identify the specific vertebra involved. Documentation should specify the fracture location.