Excludes1 pair
S22- vs S22.4-
S22 and S22.4 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.
The official note, declared on S22.4
flail chest (S22.5-)
S22
Fracture of rib(s), sternum and thoracic spine
Not billable
- Chapter 19
- Injury, poisoning and certain other consequences of external causes
- Section
- S20-S29
Use when the record says
- fracture of thoracic neural arch
- fracture of thoracic spinous process
- fracture of thoracic transverse process
- fracture of thoracic vertebra
- fracture of thoracic vertebral arch
S22.4
Multiple fractures of ribs
Not billable
- Chapter 19
- Injury, poisoning and certain other consequences of external causes
- Section
- S20-S29
Use when the record says
- Fractures of two or more ribs
Indexed under
- Fracture, traumatic › rib › multiple
- Fracture, traumatic › thorax › rib › multiple
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027