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ICD-10 Guide
ICD-10 CodesS22.05

S22.05

Billable

Fracture of T5-T6 vertebra

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

Code Description

ICD-10 S22.05 is a billable code used to indicate a diagnosis of fracture of t5-t6 vertebra.

Key Diagnostic Point:

The S22.05 code refers to a fracture of the thoracic vertebrae T5 and T6, which are located in the mid-back region. This type of fracture is often the result of significant trauma, such as a fall, motor vehicle accident, or sports injury. Patients may present with acute pain in the thoracic region, limited mobility, and neurological deficits depending on the severity of the fracture and any associated spinal cord injury. Complications can include rib fractures, pneumothorax, hemothorax, and potential cardiac injuries due to the proximity of the thoracic cavity to vital organs. Diagnosis typically involves imaging studies such as X-rays, CT scans, or MRIs to assess the extent of the injury. Treatment may range from conservative management with pain control and physical therapy to surgical interventions like vertebroplasty or spinal fusion, especially if there is instability or neurological compromise. Accurate coding is essential for proper reimbursement and to reflect the complexity of care provided.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for precise documentation of fracture type and location
  • Potential for associated injuries (e.g., rib fractures, pneumothorax)
  • Variability in treatment approaches (conservative vs. surgical)
  • Differentiation from other thoracic spine injuries

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to document associated injuries
  • Lack of clarity on treatment decisions
  • Inconsistent coding of complications

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and post-operative notes.

Common Clinical Scenarios

Fracture repair, spinal fusion, and management of complications.

Billing Considerations

Ensure documentation reflects the complexity of the surgical procedure and any complications.

Emergency Medicine

Documentation Requirements

Comprehensive assessment notes, imaging results, and treatment plans.

Common Clinical Scenarios

Initial evaluation of trauma patients, management of acute pain, and stabilization.

Billing Considerations

Accurate documentation of the mechanism of injury and any immediate interventions performed.

Coding Guidelines

Inclusion Criteria

Use S22.05 When
  • Follow official ICD
  • CM coding guidelines, ensuring accurate documentation of the fracture type, location, and any associated injuries
  • Include details on treatment and any complications that arise

Exclusion Criteria

Do NOT use S22.05 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

22551CPT Code

Percutaneous vertebroplasty

Clinical Scenario

Used in cases of vertebral compression fractures.

Documentation Requirements

Operative report detailing the procedure and indications.

Specialty Considerations

Orthopedic surgeons must document the necessity for the procedure based on imaging findings.

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. S22.05 provides a clear indication of the specific vertebrae involved, which is crucial for treatment planning and outcomes assessment.

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. S22.05 provides a clear indication of the specific vertebrae involved, which is crucial for treatment planning and outcomes assessment.

Reimbursement & Billing Impact

reimbursement processes. S22.05 provides a clear indication of the specific vertebrae involved, which is crucial for treatment planning and outcomes assessment.

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 vertebra fractures?

Common causes include high-energy trauma such as falls, motor vehicle accidents, and sports injuries. Osteoporosis can also lead to fractures in older adults.