S02.402B — Zygomatic fracture, unspecified side, initial encounter for open fracture
Is S02.402B billable?
Yes, but S02.402B will trip a Medicare edit. S02.402B is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists S02.402B under Medicare Code Editor edit 20, “Unspecified code” — meaning a code specifying laterality (right, left or bilateral) exists in the same family. On an inpatient claim this triggers the edit, because CMS holds that there are very limited circumstances in which laterality cannot be documented.
S02.402B at a glance
| Code | S02.402B |
|---|---|
| Description | Zygomatic fracture, unspecified side, initial encounter for open fracture |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "B" | initial encounter for open fracture |
What does the 7th character "B" mean in S02.402B?
In S02.402B, the 7th character B means initial encounter for open fracture. The 7th character is required for S02.402B to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
What Medicare edits apply to S02.402B?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name S02.402B directly.
A code specifying laterality (right, left or bilateral) exists in the same family. CMS holds that there are very limited circumstances in which laterality cannot be documented.
Which MS-DRGs does S02.402B group to?
S02.402B sits in MDC Pre and helps define the logic of 3 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 011Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCCsurgical
- 012Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CCsurgical
- 013Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy without CC/MCCsurgical
As a secondary diagnosis, S02.402B is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG. It also carries Hospital-Acquired Condition category 05.
How is S02.402B listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S02.402, the nearest indexed parent of S02.402B. Use them to find the family, then select the specific code.
- Fracture, traumatic › zygoma (abduction) (adduction) (separation)
Use additional code — inherited from Chapter 19
Report an additional code alongside S02.402B to fully describe the condition. S02.402B is sequenced first.
- code to identify any retained foreign body, if applicable (Z18.-)
Excludes2 — not included here — inherited from Chapter 19
The conditions below are not part of S02.402B, but a patient may have both at the same time. When documentation supports it, S02.402B and the excluded code may both be reported.
Excludes2 — not included here — inherited from S00-S09
The conditions below are not part of S02.402B, but a patient may have both at the same time. When documentation supports it, S02.402B and the excluded code may both be reported.
- burns and corrosions (T20-T32)
- effects of foreign body in ear (T16)
- effects of foreign body in larynx (T17.3)
- effects of foreign body in mouth NOS (T18.0)
- effects of foreign body in nose (T17.0-T17.1)
- effects of foreign body in pharynx (T17.2)
- effects of foreign body on external eye (T15.-)
- frostbite (T33-T34)
- insect bite or sting, venomous (T63.4)
Code also — inherited from S00-S09
Two codes may be needed to describe the condition fully. Whether S02.402B is sequenced first depends on the reason for the encounter.
- for any associated infection
Code also — inherited from S02
Two codes may be needed to describe the condition fully. Whether S02.402B is sequenced first depends on the reason for the encounter.
- any associated intracranial injury (S06.-)
How long has S02.402B existed?
S02.402B has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
- FY2018Zygomatic fracture, unspecified, initial encounter for open fractureZygomatic fracture, unspecified side, initial encounter for open fracture
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.