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ICD-10 Guide
ICD-10 CodesS22.042

S22.042

Billable

Unstable burst fracture of fourth thoracic vertebra

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

Code Description

ICD-10 S22.042 is a billable code used to indicate a diagnosis of unstable burst fracture of fourth thoracic vertebra.

Key Diagnostic Point:

An unstable burst fracture of the fourth thoracic vertebra (T4) is a severe spinal injury characterized by the shattering of the vertebral body due to high-energy trauma, such as a fall or motor vehicle accident. This type of fracture can lead to significant spinal instability and potential neurological compromise. The fracture typically results in fragments of the vertebra displacing into the spinal canal, which may compress the spinal cord or nerve roots, leading to symptoms such as pain, weakness, or paralysis. Associated injuries may include rib fractures, pneumothorax, hemothorax, and cardiac injuries due to the proximity of the thoracic spine to vital thoracic structures. Management often requires surgical intervention, such as decompression and stabilization, to prevent further neurological damage and restore spinal integrity. Accurate coding of this condition is crucial for appropriate treatment planning and reimbursement.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires detailed documentation of the mechanism of injury.
  • Involves understanding of associated thoracic injuries.
  • Needs precise identification of the vertebral level affected.
  • Potential for neurological involvement complicates coding.

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury.
  • Failure to document associated injuries like pneumothorax or hemothorax.
  • Misidentification of the vertebral level involved.
  • Lack of clarity regarding surgical interventions performed.

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging studies, and pre/post-operative assessments.

Common Clinical Scenarios

Management of unstable spinal fractures, surgical fixation, and rehabilitation.

Billing Considerations

Ensure documentation reflects the complexity of the fracture and any neurological assessments.

Trauma Surgery

Documentation Requirements

Comprehensive trauma assessments, including mechanism of injury and associated injuries.

Common Clinical Scenarios

Emergency management of thoracic trauma, including stabilization and surgical intervention.

Billing Considerations

Document all associated injuries and their management to support coding.

Coding Guidelines

Inclusion Criteria

Use S22.042 When
  • Follow official ICD
  • CM guidelines for coding injuries, including the use of seventh characters for subsequent encounters and the need for specificity in documenting the type of fracture and associated injuries

Exclusion Criteria

Do NOT use S22.042 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22554CPT Code

Percutaneous vertebroplasty

Clinical Scenario

Used in cases of vertebral fractures requiring stabilization.

Documentation Requirements

Operative report detailing the procedure and indications.

Specialty Considerations

Orthopedic surgeons must document the necessity of the procedure based on fracture stability.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of unstable burst fractures, improving the accuracy of clinical data and reimbursement processes. This specificity aids in better tracking of outcomes and resource utilization.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of unstable burst fractures, improving the accuracy of clinical data and reimbursement processes. This specificity aids in better tracking of outcomes and resource utilization.

Reimbursement & Billing Impact

reimbursement processes. This specificity aids in better tracking of outcomes and resource utilization.

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 difference between stable and unstable burst fractures?

Stable burst fractures do not compromise spinal stability or neurological function, while unstable burst fractures involve significant displacement of vertebral fragments, risking spinal cord injury and requiring surgical intervention.