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ICD-10 Guide
ICD-10 CodesS02.61

S02.61

Billable

Fracture of condylar process of mandible

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

Code Description

ICD-10 S02.61 is a billable code used to indicate a diagnosis of fracture of condylar process of mandible.

Key Diagnostic Point:

The condylar process of the mandible is a critical anatomical structure that articulates with the temporal bone of the skull, forming the temporomandibular joint (TMJ). A fracture of this area can occur due to various mechanisms, including direct trauma from falls, motor vehicle accidents, or physical altercations. Symptoms typically include pain, swelling, limited jaw movement, and sometimes malocclusion. Diagnosis is primarily through clinical examination and imaging studies, such as X-rays or CT scans, which can reveal the extent and nature of the fracture. Management often involves conservative treatment with pain control and soft diet, but surgical intervention may be necessary for displaced fractures or those causing significant functional impairment. Complications can include nonunion, malocclusion, and TMJ dysfunction, which may require further surgical correction. Accurate coding is essential for proper reimbursement and tracking of treatment outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture presentation and severity
  • Need for imaging studies to confirm diagnosis
  • Potential for associated injuries in polytrauma cases
  • Differentiation from other mandibular fractures

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the type of fracture (e.g., open vs. closed)
  • Lack of imaging results in the medical record
  • Inconsistent coding of associated injuries

Specialty Focus

Medical Specialties

Emergency Medicine

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with facial trauma after a fall or altercation, requiring immediate evaluation and imaging.

Billing Considerations

Ensure that all relevant injuries are documented to support the coding of S02.61 and any associated procedures.

Surgery

Documentation Requirements

Operative reports must detail the surgical approach, fixation methods used, and postoperative care plans.

Common Clinical Scenarios

Surgical repair of a displaced condylar fracture requiring open reduction and internal fixation.

Billing Considerations

Document any complications or additional procedures performed during surgery to ensure accurate coding.

Coding Guidelines

Inclusion Criteria

Use S02.61 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used in conjunction with appropriate external cause codes (e
  • , V codes for the mechanism of injury) when applicable

Exclusion Criteria

Do NOT use S02.61 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

21110CPT Code

Open reduction of mandibular fracture

Clinical Scenario

Used when surgical intervention is required for a condylar process fracture.

Documentation Requirements

Operative report detailing the procedure performed and any complications.

Specialty Considerations

Ensure that the surgical approach is clearly documented to support the coding.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, including the condylar process, which enhances data accuracy and improves patient care tracking.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including the condylar process, which enhances data accuracy and improves patient care tracking.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of fractures, including the condylar process, which enhances data accuracy and improves patient care tracking.

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 imaging is required to confirm a condylar process fracture?

Typically, X-rays are the first step, but a CT scan may be necessary for a detailed assessment of the fracture.