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S02.19XA

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S02.19XA — Other Fracture of Base of Skull, Initial Encounter for Closed Fracture

Code Overview

S02.19XA is a billable ICD-10-CM diagnosis code for other fracture of base of skull, initial encounter for closed fracture. It belongs to the S02 category — Fracture of skull and facial bones — within Chapter 19 (Injury, Poisoning and Certain Other Consequences of External Causes, S00-T88). The 7th character “A” designates initial encounter, meaning the patient is actively receiving evaluation and treatment for this traumatic fracture.

The “other” designation makes this a NEC (not elsewhere classified) residual code within the S02.1 subcategory. It captures skull base fractures that are specifically identified by anatomical location within the base of the skull but do not map to the more laterality-specific S02.10-S02.12 codes. It is the closed fracture variant — meaning no external open wound communicates with the fracture site — as opposed to S02.19XB (open fracture).

Full Code Description

ElementDetail
Full CodeS02.19XA
DescriptionOther fracture of base of skull, initial encounter for closed fracture
Fracture TypeClosed (no communicating external wound)
7th CharacterA = initial encounter for closed fracture
Placeholder”X” in 5th and 6th positions — structural placeholder only, no clinical meaning
BillableYes
Chapter19 — Injury, Poisoning and Certain Other Consequences of External Causes
BlockS00-S09 — Injuries to the head
CategoryS02 — Fracture of skull and facial bones
SubcategoryS02.1 — Fracture of base of skull
Valid FYFY2025 (Oct 1, 2024 - Sep 30, 2025)
Code AlsoAny associated intracranial injury (S06.-)
External CauseRequired — document mechanism of injury with V/W/X/Y code

Includes Notes (S02.19)

The ICD-10-CM Alphabetic Index and Tabular List explicitly identify the following anatomical fractures as included under S02.19:

Included Fracture LocationAnatomical Context
Fracture of anterior fossa of base of skullThe anterior cranial fossa houses the frontal lobes and olfactory tracts; the floor is formed by the ethmoid, frontal, and sphenoid bones
Fracture of ethmoid sinusThe cribriform plate of the ethmoid forms part of the anterior fossa floor; fracture here risks CSF rhinorrhea and anosmia
Fracture of frontal sinusPosterior wall fractures of the frontal sinus are considered skull base fractures when they involve the anterior fossa floor
Fracture of middle fossa of base of skullThe middle cranial fossa houses the temporal lobes and pituitary; formed by the sphenoid and temporal bones
Fracture of occipital condyleThe condylar articulation with the atlas (C1); fractures here are mechanically distinct from lateral occipital bone fractures
Fracture of posterior fossa of base of skull NECThe posterior fossa houses the brainstem and cerebellum; floor is formed by the occipital bone and petrous temporal bone
Fracture of sella turcicaThe bony seat of the pituitary gland in the sphenoid bone; fractures risk pituitary injury and CSF leak
Fracture of temporal bone (involving skull base)The petrous and tympanic portions may be involved; risk of hemotympanum, hearing loss, facial nerve injury

Clinical Description

A skull base fracture involves disruption of the bony floor of the cranial cavity — the complex three-dimensional platform on which the brain rests and through which critical neurovascular structures pass. Skull base fractures are almost exclusively the result of significant head trauma and carry a high association with intracranial injury, cranial nerve damage, and vascular injury.

Anatomy Relevant to S02.19XA

The skull base is divided into three fossae:

Anterior cranial fossa:

  • Formed by: frontal bone (orbital plates), ethmoid bone (cribriform plate), lesser wing of sphenoid

  • Contents at risk: olfactory nerves (CN I) through cribriform plate foramina, frontal lobes

  • Fracture signs: anosmia, CSF rhinorrhea (rhinorrhea of clear fluid = CSF leak through cribriform plate), periorbital ecchymosis (raccoon eyes / periorbital hematoma)

Middle cranial fossa:

  • Formed by: greater wing of sphenoid, temporal bone (squamous and petrous portions)

  • Contents at risk: CN II-VI (optic canal, superior orbital fissure, foramen rotundum, foramen ovale), internal carotid artery (cavernous segment), pituitary gland (sella turcica)

  • Fracture signs: CSF otorrhea (if dura torn and petrous bone fractured with tympanic membrane rupture), hemotympanum, Battle’s sign (retroauricular ecchymosis), CN III/IV/VI palsies, facial nerve (CN VII) injury, vestibulocochlear (CN VIII) injury causing hearing loss or vertigo

Posterior cranial fossa:

  • Formed by: occipital bone, petrous and mastoid portions of temporal bone, dorsum sellae of sphenoid

  • Contents at risk: brainstem, cerebellum, CN VII-XII, vertebral arteries, basilar artery, sigmoid and transverse sinuses

  • Fracture signs: Battle’s sign, CN IX-XII deficits, hemodynamic instability if vascular injury, respiratory compromise

Mechanism of Injury

  • High-velocity blunt trauma: Motor vehicle accidents, motorcycle crashes, falls from height

  • Direct impact: Blows to the occiput, temporal region, or forehead with sufficient force

  • Contre-coup forces: Forces transmitted through the skull vault to the base

  • Axial loading: Falls on feet or buttocks can transmit force through the spine and base of skull (occipital condyle fractures)

  • Blast injuries: Military/combat contexts; air pressure wave transmitted through the skull base

Clinical Signs and Symptoms

Classic exam findings in skull base fractures:

  • Raccoon eyes (periorbital ecchymosis) — bilateral periorbital bruising from blood tracking through anterior fossa; develops hours after injury

  • Battle’s sign (retroauricular ecchymosis) — bruising behind the ear over the mastoid process; indicates petrous temporal bone or posterior fossa fracture

  • CSF rhinorrhea — clear watery nasal discharge; positive beta-2 transferrin test confirms CSF; indicates anterior fossa dural tear through cribriform plate

  • CSF otorrhea — clear fluid from the ear canal; indicates petrous bone fracture with dural tear and ruptured tympanic membrane

  • Hemotympanum — blood behind the tympanic membrane visible on otoscopy; indicates middle fossa (petrous) fracture

  • CN VII palsy (facial nerve) — peripheral facial weakness; may be immediate (nerve transection) or delayed (edema/hematoma)

  • CN VIII deficit — sensorineural hearing loss, tinnitus, vertigo; from petrous bone fracture involving the cochlea or IAC

  • Anosmia — loss of smell from cribriform plate fracture (CN I)

  • Altered consciousness — from associated intracranial injury; level of consciousness critically determines DRG assignment

Severity and Associated Injuries

Skull base fractures are rarely isolated — they almost universally occur with associated intracranial injuries:

  • Epidural hematoma — arterial (middle meningeal artery in middle fossa), venous (dural sinus injury)

  • Subdural hematoma — bridging vein disruption, often associated with more diffuse brain injury

  • Subarachnoid hemorrhage (traumatic) — from arterial injury or contusion

  • Cerebral contusion or laceration — direct or contre-coup

  • Diffuse axonal injury (DAI) — from acceleration/deceleration forces

  • Pneumocephalus — air entering the intracranial compartment through fracture lines and dural tears

  • Carotid artery or vertebral artery injury — potentially catastrophic; requires CTA evaluation

  • Meningitis — delayed complication from CSF fistula creating a pathway for bacterial entry

7th Character Table

7th CharacterFull CodeDescriptionWhen to Use
AS02.19XAInitial encounter — closed fractureActive treatment phase; ED, hospitalization, acute surgical management
BS02.19XBInitial encounter — open fractureFracture with communicating external wound; code B when open
DS02.19XDSubsequent encounter — routine healingFollow-up visits during normal healing; patient no longer in acute phase
GS02.19XGSubsequent encounter — delayed healingSlower than expected healing during follow-up
KS02.19XKSubsequent encounter — nonunionFracture fails to unite
SS02.19XSSequelaLate effects attributable to the healed skull base fracture (e.g., chronic anosmia, chronic CN palsy)

Tip

7th character “A” guidance: Per ICD-10-CM Official Guidelines, the “A” (initial encounter) character should be used for every visit during the active treatment phase, regardless of whether the patient is seeing a new provider. A patient admitted to the hospital on day 3 still receives “A” if they are actively being treated for the fracture.

Code Structure / Code Tree

S00-T88    Injury, poisoning and certain other consequences of external causes
  └── S00-S09    Injuries to the head
        └── S02    Fracture of skull and facial bones
              ├── S02.0    Fracture of vault of skull
              │     ├── S02.0XXA    ... initial encounter, closed
              │     └── S02.0XXB    ... initial encounter, open
              ├── S02.1    Fracture of base of skull    ◄ SUBCATEGORY
              │     ├── S02.10    Unspecified fracture of base of skull
              │     │     ├── S02.101A    ... right side, closed
              │     │     ├── S02.102A    ... left side, closed
              │     │     └── S02.109A    ... unspecified side, closed
              │     ├── S02.11    Fracture of occiput
              │     │     ├── S02.110A-S02.119A    (type I-III condylar, unilateral/bilateral)
              │     ├── S02.12    Fracture of orbital roof
              │     │     ├── S02.121A    ... right side
              │     │     ├── S02.122A    ... left side
              │     │     └── S02.129A    ... unspecified
              │     └── S02.19    Other fracture of base of skull    ◄ PARENT CODE (non-billable)
              │           ├── S02.19XA    ... initial encounter, closed fracture    ◄ THIS CODE
              │           ├── S02.19XB    ... initial encounter, open fracture
              │           ├── S02.19XD    ... subsequent, routine healing
              │           ├── S02.19XG    ... subsequent, delayed healing
              │           ├── S02.19XK    ... subsequent, nonunion
              │           └── S02.19XS    ... sequela
              ├── S02.2    Fracture of nasal bones
              ├── S02.3    Fracture of orbital floor
              ├── S02.4    Malar, maxillary, and zygomatic fractures
              ├── S02.5    Fracture of tooth
              ├── S02.6    Fracture of mandible
              ├── S02.8    Fractures of other skull and facial bones
              └── S02.9    Fracture of skull and facial bones, part unspecified

Includes / Excludes Notes

Includes (S02.19)

As listed in the ICD-10-CM Tabular List:

  • Fracture of anterior fossa of base of skull

  • Fracture of ethmoid sinus

  • Fracture of frontal sinus (posterior wall, involving skull base)

  • Fracture of middle fossa of base of skull

  • Fracture of occipital condyle (types not separately coded in S02.11)

  • Fracture of posterior fossa of base of skull (NEC)

  • Fracture of sella turcica

  • Fracture of temporal bone (skull base component)

Excludes2 (S02.1 Subcategory — May Code Additionally When Present)

The following are not included in S02.1 but may exist simultaneously and be coded additionally:

CodeDescriptionCoding Note
S02.84-Lateral orbital wall fractureCode separately if lateral orbital wall involved
S02.83-Medial orbital wall fractureCode separately if medial orbital wall involved
S02.3-Fracture of orbital floorDo not include in S02.19; code additionally

Code Also (Mandatory Instructional Note — S02)

Code also any associated intracranial injury (S06.-)

This is a critical coding instruction at the S02 category level. Any documented intracranial injury must be coded additionally alongside S02.19XA:

CodeAssociated Intracranial Injury
S06.0X-AConcussion, initial encounter
S06.1-ATraumatic cerebral edema, initial encounter
S06.2-ADiffuse traumatic brain injury, initial encounter
S06.3-AFocal traumatic brain injury, initial encounter
S06.4-AEpidural hemorrhage, initial encounter
S06.5-ATraumatic subdural hemorrhage, initial encounter
S06.6-ATraumatic subarachnoid hemorrhage, initial encounter

External Cause Code Required

Chapter 19 injuries require external cause codes from V00-Y99 to identify the mechanism and place of injury. Common pairings with S02.19XA:

External Cause CodeDescription
V03.1XXAPedestrian on foot injured in collision with car, initial
V49.9XXACar occupant injured in unspecified traffic accident, initial
W01.110AFall on same level from slipping — striking head on sidewalk, initial
W17.89XAOther fall from one level to another, initial
X50.XXXAOverexertion from sports activity, initial
Y93.89Activity, other specified
Y99.8Other external cause status

HCC (Hierarchical Condition Category) Mapping

S02.19XA itself does NOT map to a CMS-HCC in standard risk adjustment models.

HCC ModelHCC AssignmentRAF Impact
CMS-HCC Model V28Not assignedNo RAF
RxHCC ModelNot assignedNo RAF
HHS-HCC (ACA Marketplace)Not assignedNo RAF

Note

Associated HCC consideration: While S02.19XA does not carry HCC weight, the intracranial injury codes (S06.-) coded alongside it may — depending on severity and documentation. Additionally, sequelae of skull base fractures that produce permanent neurological deficits (e.g., hemiplegia, aphasia, cognitive impairment) map to significant HCCs in the sequela phase of care. Accurate long-term coding of lasting deficits is critical for RAF in chronic TBI patients.

MS-DRG Mapping (Inpatient)

S02.19XA is almost exclusively an inpatient diagnosis due to the severity of skull base fractures. The DRG is heavily influenced by the associated intracranial injury codes (S06.-), particularly the documented duration of loss of consciousness (LOC).

Primary DRG Groupings

MS-DRGDescriptionTrigger
082Traumatic Stupor and Coma, Coma > 1 hour with MCCS06.- codes with LOC > 1 hr + MCC
083Traumatic Stupor and Coma, Coma > 1 hour with CCS06.- codes with LOC > 1 hr + CC
084Traumatic Stupor and Coma, Coma > 1 hour without CC/MCCS06.- codes with LOC > 1 hr
085Traumatic Stupor and Coma, Coma 1-59 min with MCCS06.- codes with LOC 1-59 min + MCC
086Traumatic Stupor and Coma, Coma 1-59 min with CCS06.- codes with LOC 1-59 min + CC
087Traumatic Stupor and Coma, Coma 1-59 min without CC/MCCS06.- codes with LOC 1-59 min
088Concussion with MCCS06.0X-A (concussion) + MCC
089Concussion with CCS06.0X-A (concussion) + CC
090Concussion without CC/MCCS06.0X-A (concussion) only
955Craniotomy for Multiple Significant TraumaSurgical craniotomy performed + multiple trauma

MDC: MDC 01 — Diseases and Disorders of the Nervous System

CC/MCC Status of S02.19XA Itself

S02.19XA functions as a CC (complication/comorbidity) when it appears as a secondary diagnosis in certain MS-DRG assignments, contributing to DRG severity upgrade. As the principal diagnosis, it drives grouping to the skull/head trauma DRG families above.

DRG Documentation Critical Point: The LOC duration documented in the medical record is the single most impactful variable in skull base fracture DRG assignment. LOC must be explicitly stated in minutes/hours by the treating physician. Vague terms like “altered consciousness” or “GCS of X” are insufficient — the coder must query the physician for documented LOC duration if not explicitly stated. LOC duration is captured in the S06.- code selection.

CPT Procedure Codes (Commonly Associated)

Emergency and Diagnostic

CPTDescriptionwRVU (approx.)Notes
70450CT head without contrast1.50First-line imaging for skull fracture and intracranial injury
70460CT head with contrast1.90For vascular injury or infection concern
70470CT head with and without contrast2.00When both phases needed
70480CT orbit/sella/posterior fossa without contrast1.50For specific skull base region imaging
70490CT soft tissue neck without contrast1.50If cervical injury also present
70544MRA head without contrast2.50Vascular injury screening (carotid/vertebral dissection)
70553MRI brain with and without contrast2.50For detailed parenchymal injury, posterior fossa
70010Myelography, posterior fossa2.50Rarely used
99291Critical care, first 30-74 minutes4.50ICU/acute care, neuro monitoring
99292Critical care, each additional 30 min2.25Additional critical care units

Neurological/Neurosurgical Monitoring

CPTDescriptionwRVU (approx.)Assistant Allowed?
95822EEG, recording in coma or sleep only~1.50No
61107Twist drill hole for subdural drainage (ICP monitoring/hematoma)~8.56No
61210Burr hole(s) for ventricular drainage; catheter placement~11.70No
61105Twist drill hole for ventricular puncture, diagnostic~5.78No

Surgical Procedures for Skull Base Fracture Management

Skull base surgery uses a 3-component coding structure for open procedures: (1) Approach, (2) Definitive procedure, (3) Reconstruction.

Fracture Elevation / Repair

CPTDescriptionwRVU (approx.)Assistant Allowed?
62000Elevation of depressed skull fracture; simple, extradural~14.86Yes
62005Elevation of depressed skull fracture; compound or comminuted, extradural~20.76Yes
62010Elevation of depressed skull fracture; with repair of dura and/or debridement of brain~26.97Yes
62100Craniotomy for repair of dural/CSF leak, including surgery for rhinorrhea/otorrhea~27.68Yes

Skull Base Approach Codes (61580-61598)

CPTDescriptionwRVU (approx.)Assistant Allowed?
61580Craniofacial approach to anterior cranial fossa; extradural~36.98Yes
61581Craniofacial approach to anterior cranial fossa; combined extradural and intradural~43.47Yes
61582Craniofacial approach to anterior cranial fossa; extradural, with orbital exenteration~42.60Yes
61590Infratemporal pre-auricular approach to middle cranial fossa~48.88Yes
61591Infratemporal post-auricular approach to middle cranial fossa~48.88Yes
61595Transtemporal approach to posterior cranial fossa~47.05Yes
61596Transcochlear approach to posterior cranial fossa~47.05Yes
61598Transpetrosal approach to posterior cranial fossa~48.88Yes

Definitive Procedure Codes (61600-61616)

CPTDescriptionwRVU (approx.)Assistant Allowed?
61600Resection/excision of neoplastic/vascular/infectious lesion, anterior cranial fossa; extradural~43.78Yes
61601… anterior cranial fossa; intradural~50.01Yes
61605… middle cranial fossa; extradural or combined~50.32Yes
61606… middle cranial fossa; intradural~54.86Yes
61615… posterior cranial fossa; extradural~50.32Yes
61616… posterior cranial fossa; intradural~60.12Yes

Reconstruction (61618-61619)

CPTDescriptionwRVU (approx.)Assistant Allowed?
61618Secondary repair of dura for CSF leak, anterior fossa~20.15Yes
61619Secondary repair of dura for CSF leak, other cranial fossa~24.18Yes

Skull base surgery coding note:

When both an approach code and a definitive procedure code are performed, both are reported. The approach + definitive combination is the standard for open skull base surgery. Reconstruction codes are added only when separately performed. All major skull base surgical procedures allow assistant surgeon billing.

ICP Monitoring (Intracranial Pressure)

CPTDescriptionwRVU (approx.)Assistant Allowed?
61107Twist drill placement for ICP monitor or subdural drainage~8.56No
62161Neuroendoscopy with ventricular catheter placement~16.34No

Coding Examples

Example 1 — Skull Base Fracture with CSF Rhinorrhea, ED and Hospital Admission

Clinical Scenario:
A 32-year-old male is brought to the ED after an MVC. He had a brief LOC estimated at approximately 15 minutes. CT of the head reveals a fracture of the cribriform plate with pneumocephalus. Clear fluid is draining from the right nostril; beta-2 transferrin confirms CSF rhinorrhea. He is admitted to neurosurgery for monitoring. No surgical intervention is required; the CSF leak resolves with conservative management.

ICD-10-CM:

  • S02.19XA — Other fracture of base of skull, initial encounter for closed fracture (cribriform plate = anterior fossa, covered under S02.19)

  • S06.0X1A — Concussion with LOC of 30 minutes or less, initial encounter (brief LOC documented; code also per S02 instructional note)

  • S09.90XA — Unspecified injury of head, initial encounter (pneumocephalus — if not separately coded)

  • V49.50XA — Driver injured in collision with unspecified motor vehicle in traffic accident, initial encounter (external cause)

  • Y93.89 — Activity, other specified

CPT:

  • 70450 — CT head without contrast

  • 70460 — CT head with contrast (follow-up to evaluate vascular injury)

  • 99291 — Critical care services, first 30-74 min (if critical care provided)

Example 2 — Petrous Temporal Bone Fracture with Facial Nerve Palsy

Clinical Scenario:
A 45-year-old female falls down stairs, striking the right side of her head. CT reveals a longitudinal fracture through the right petrous temporal bone with hemotympanum. She develops right peripheral facial nerve palsy (CN VII) within 24 hours and hearing loss on the right. LOC of approximately 45 minutes documented in the ED note. Admitted to neurosurgery/neurotology for observation and steroid therapy.

ICD-10-CM:

  • S02.19XA — Other fracture of base of skull, initial encounter for closed fracture (petrous temporal bone = middle fossa component of S02.19)

  • S06.0X1A — Concussion with LOC 30 minutes or less, initial encounter (if LOC was < 30 min) OR S06.0X2A if 30-59 min

  • S04.51XA — Injury of facial nerve, right side, initial encounter (CN VII palsy from fracture)

  • S04.61XA — Injury of acoustic nerve, right side, initial encounter (hearing loss from CN VIII involvement)

  • W10.9XXA — Fall on and from unspecified stairs and steps, initial encounter (external cause)

CPT:

  • 70480 — CT posterior fossa/temporal bone without contrast

  • 70553 — MRI brain with/without contrast (facial nerve evaluation)

  • 92557 — Comprehensive audiometry (hearing evaluation)

  • 99214 or 99215 — Follow-up evaluation during admission per day

Example 3 — Posterior Fossa Skull Base Fracture, Surgical Repair for CSF Otorrhea

Clinical Scenario:
A 58-year-old male sustains a posterior fossa skull base fracture after a fall from height. He develops persistent CSF otorrhea that fails conservative management at 2 weeks. He returns to the OR for open craniotomy for repair of the CSF leak/dural tear. LOC was > 1 hour post-injury. He has been in hospital throughout; this is still the initial treatment encounter.

ICD-10-CM (inpatient — surgery encounter):

  • S02.19XA — Other fracture of base of skull, initial encounter for closed fracture

  • S06.2X5A — Diffuse traumatic brain injury with LOC > 24 hours, initial encounter (if applicable per documented LOC duration)

  • W17.89XA — Other fall from one level to another, initial encounter

CPT (surgical):

  • 62100 — Craniotomy for repair of dural/CSF leak, including surgery for otorrhea/rhinorrhea

  • 61619 — Secondary repair of dura for CSF leak, other cranial fossa (if reconstruction separately coded)

Assistant surgeon: Yes, billable for both 62100 and 61619 per MPFS assistant indicator.

Example 4 — Occipital Condyle Fracture with Axial Loading Mechanism

Clinical Scenario:
A 22-year-old female gymnast falls and lands directly on her head with axial loading force. CT reveals a fracture of the right occipital condyle at the skull base with no associated intracranial hemorrhage. No LOC documented. She is managed with cervical orthosis. C-spine imaging is negative for ligamentous injury.

ICD-10-CM:

  • S02.19XA — Other fracture of base of skull, initial encounter for closed fracture (occipital condyle fracture is included under S02.19)

  • W18.39XA — Other fall on same level, initial encounter (external cause)

  • Y93.35 — Activity, gymnastics (activity code)

Coding note:

Occipital condyle fractures are included in the S02.19 “Includes” notes. Do not separately code with S02.11 unless the specific condyle fracture type is assigned there per the Tabular.

Example 5 — Encounter Type Progression (A → D → S)

Same patient as Example 1:

  • ED and hospitalization (active fracture management): S02.19XA — initial encounter for closed fracture

  • Neurosurgery office follow-up 6 weeks later (healing normally, monitoring anosmia): S02.19XD — subsequent encounter for fracture with routine healing

  • 12 months later (permanent loss of smell as residual): S02.19XS + R43.0 — anosmia as sequela of skull base fracture

Key Coding Pitfalls & Tips

  • Always code also the intracranial injury. The ICD-10-CM Tabular List includes a mandatory “Code also any associated intracranial injury (S06.-)” instruction at the S02 category level. Failure to code S06.- when documented is a coding error and a significant DRG accuracy issue.

  • LOC duration drives the DRG — query the physician. The S06.- codes are stratified by LOC duration. Coders must ensure the clinical documentation explicitly states LOC duration in minutes/hours. A note that says only “altered mental status” or “GCS 12 on arrival” is insufficient — query for LOC documentation.

  • Open vs. closed matters — check for skin wound communication. S02.19XA is for closed fractures. If there is a laceration or wound communicating with the fracture site (open fracture), use S02.19XB instead.

  • “X” placeholder is not optional. The full code is always written S02.19XA — not S02.19A. The X placeholders in positions 5 and 6 are structurally required; omitting them creates an invalid code.

  • Do not use for orbital fractures. The Excludes2 note at S02.1 directs lateral orbital wall (S02.84-), medial orbital wall (S02.83-), and orbital floor (S02.3-) fractures to their own codes. These are not captured in S02.19XA.

  • External cause codes are expected. Chapter 19 injuries require V/W/X/Y external cause codes. Complete coding includes mechanism (e.g., MVA, fall), place of occurrence (Y93.-), and activity (Y99.-) when documented.

  • Sequela coding for permanent deficits. Skull base fractures can produce lasting neurological deficits (anosmia, CN palsies, hearing loss, cognitive impairment). In the sequela phase, code S02.19XS as the “cause” code, plus the specific residual condition code (e.g., H91.92 for unspecified hearing loss, R43.0 for anosmia). The sequela code comes after the residual condition code in sequencing.

CodeDescription
S02.19XBOther fracture of base of skull, initial encounter for open fracture
S02.19XDOther fracture of base of skull, subsequent encounter, routine healing
S02.19XSOther fracture of base of skull, sequela
S02.0XXAFracture of vault of skull, initial encounter, closed
S02.10XAUnspecified fracture of base of skull, initial encounter, closed
S02.101AFracture of base of skull, right side, initial encounter, closed
S02.102AFracture of base of skull, left side, initial encounter, closed
S02.11-AFracture of occiput (condylar types), initial encounter
S02.121AFracture of orbital roof, right side, initial encounter
S02.3-AFracture of orbital floor (Excludes2 from S02.1)
S02.83-AMedial orbital wall fracture (Excludes2 from S02.1)
S02.84-ALateral orbital wall fracture (Excludes2 from S02.1)
S06.0X-AConcussion, initial encounter — Code Also
S06.4-AEpidural hemorrhage, initial encounter — Code Also
S06.5-ATraumatic subdural hemorrhage, initial encounter — Code Also
S06.6-ATraumatic subarachnoid hemorrhage, initial encounter — Code Also
S04.51XAInjury of facial nerve, right side, initial encounter
S04.61XAInjury of acoustic nerve, right side, initial encounter
S09.90XAUnspecified injury of head, initial encounter
R43.0Anosmia (sequela of cribriform plate fracture)
H91.92Unspecified hearing loss (sequela of petrous bone fracture)

Last Reviewed: 2026-02-18 | Source: ICD-10-CM FY2025, CMS IPPS MS-DRG v42.0, CMS Physician Fee Schedule, ICD-10-CM Official Guidelines Chapter 19, DoD TBI Coding Guide

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