Crystal's Coder Hub🧬 ICD-10 CM S02.601A — Fracture Of Unspecified Part Of Body Of Right Mandible, Initial Encounter For Closed Fracture
Billable Code Confirmed
ICD-10 CM S02.601A is a valid, billable 7-character ICD-10-CM code for FY2026. The 6th character
1specifies the right side, and the 7th characterAspecifies that this is the initial encounter for active treatment of a closed fracture. No additional characters are required.
Non-Billable Parent Codes — Never Submit These
- ❌
S02.601— 6-character header — missing the 7th character encounter and fracture type designator (A, B, D, G, K, S).- ❌
S02.60— 5-character header — missing laterality specificity and 7th character.Always submit S02.601A (all 7 characters) when a closed fracture of the right mandibular body is documented with active treatment/initial encounter.
Clinical Context: Specificity Matters
ICD-10-CM S02.601A captures a closed fracture of the mandibular body where the side is specifically documented as right. Securing this laterality is crucial, as submitting an “unspecified side” code for a bilateral organ/structure frequently triggers immediate payer denials for traumatic injuries1.
Code Classification
ICD-10 CM Diagnosis Code — wRVU, assistant payable, and global period fields are not applicable to diagnosis codes; see the Commonly Associated CPT Codes and ICD-10-PCS Crosswalk sections for procedural and billing equivalents.
🔍 Code Description
ICD-10 CM S02.601A classifies Fracture of unspecified part of body of right mandible, initial encounter for closed fracture. This diagnosis code represents the initial phase of care (active treatment, such as emergency evaluation, wiring, or surgical reduction) for a break in the right body of the lower jaw bone, without an open wound communicating with the fracture2.
The mandibular body is the horizontal portion of the lower jaw that holds the lower teeth, extending from the angle of the jaw to the symphysis (midline). Fractures here often result from blunt force trauma, motor vehicle collisions, or falls. A “closed” fracture means the bone is broken but has not punctured the overlying facial skin or the internal oral mucosa. The 7th character “A” indicates the patient is receiving active, initial treatment.
🌳 Code Tree / Hierarchy
S02 Fracture of skull and facial bones ❌ Non-billable
│
├── S02.4 Fracture of malar, maxillary and zygomatic bones ❌ Non-billable
├── S02.6 Fracture of mandible ❌ Non-billable
│ │
│ ├── S02.60 Fracture of unspecified part of body of mandible and unspecified fracture of mandible ❌ Non-billable
│ │ │
│ │ ├── S02.600 Fracture of unspecified part of body of mandible, unspecified side ❌ Non-billable
│ │ │
│ │ ├── S02.601 Fracture of unspecified part of body of right mandible ❌ Non-billable
│ │ │ │
│ │ │ ├── S02.601A Fracture of unspecified part of body of right mandible, initial encounter for closed fracture ◀ THIS CODE ✅ Billable
│ │ │ └── S02.601B Fracture of unspecified part of body of right mandible, initial encounter for open fracture ✅ Billable
│ │ │
│ │ └── S02.602 Fracture of unspecified part of body of left mandible ❌ Non-billable
│ │
│ └── S02.61 Fracture of condylar process of mandible ❌ Non-billable
│
└── S02.8 Other fractures of skull and facial bones ❌ Non-billable
Specificity Insight
CPT S02.601A implies the provider did not specify which exact part of the right body (e.g., alveolar process versus basal bone) was fractured, but did specify it was the body and on the right side. This is generally acceptable for billing, but ensure the fracture is not actually of the condyle (
S02.61-), symphysis (S02.64-), or angle (S02.65-).
✅ Includes
The following clinical terms and scenarios map to S02.601A when documented:
- Closed fracture of the right body of the mandible
- Right mandibular body fracture, initial encounter
- Broken right jaw (body region) receiving active treatment
- Non-displaced right mandibular body fracture with intact oral mucosa
❌ Excludes
Excludes 1 — Cannot Be Coded Simultaneously with S02.601A
| Code | Description | Note |
|---|---|---|
| S02.92XA | Unspecified fracture of facial bones, initial encounter for closed fracture | Mutually exclusive. Code S02.601A provides greater anatomic specificity for a facial bone fracture and overrides the unspecified facial bone code. |
Excludes 1 Violation Risk
Never report an unspecified facial bone or generic skull fracture code alongside a specific right mandibular fracture code for the very same injury site.
Excludes 2 — May Be Coded in Addition if Separately Present
| Code | Description | Note |
|---|---|---|
| S06.9X0A | Unspecified intracranial injury without loss of consciousness, initial encounter | Code both if the patient sustained an intracranial injury alongside the right mandibular fracture. |
| S12.9XXA | Fracture of neck, unspecified, initial encounter | Code both if the trauma mechanism also resulted in a cervical spine fracture. |
📋 Clinical Overview
Open vs. Closed Fracture Distinction
Accurate fracture coding relies heavily on whether the fracture is open or closed, which dictates the 7th character.
| Feature | S02.601A — Closed | S02.601B — Open |
|---|---|---|
| Skin/Mucosa | Intact. The bone does not break the surface. | Compromised. The bone pierces the facial skin or oral mucosa. |
| Infection Risk | Lower; minimal environmental exposure. | High; oral bacteria can directly enter the fracture site. |
| 7th Character | A | B |
Documentation Tip — The "Mucosal Breach" Trap
If the medical record does not specify whether a fracture is open or closed, ICD-10-CM guidelines dictate that it should be coded as closed1. However, mandibular body fractures frequently breach the oral mucosa due to the thin tissue over the alveolar ridge. If the note mentions “mucosal laceration over the fracture site” or “tooth root exposed in fracture line,” it must be coded as an open fracture (7th character B: S02.601B).
Manifestations & Symptom Burden
Patients presenting with a right mandibular body fracture typically demonstrate the following signs and symptoms:
- malocclusion: The teeth do not align properly when the mouth is closed.
- Trismus: Inability to fully open the mouth due to pain or structural compromise.
- Facial Asymmetry: Visible swelling, bruising, or step-off deformity along the right lower jaw line.
- Paresthesia: Numbness of the right lower lip or chin due to compression or injury of the right inferior alveolar nerve2.
Coding Manifestations
The fracture code (S02.601A) is the primary diagnosis. You do not need to separately code symptoms like malocclusion or trismus if they are routine manifestations of the acute fracture itself.
💰 HCC Risk Adjustment (CMS-HCC v28)
| Field | Detail |
|---|---|
| CMS-HCC Model Version | v28 (2024-2025 Implementation) |
| HCC Assignment | ❌ Not HCC-Mapped |
| HCC Category | N/A |
| RAF Coefficient | N/A |
S02.601A does not map to an HCC under v284. Acute fractures of the facial bones are considered short-term, resolving conditions and do not typically carry long-term risk adjustment weight unless they result in permanent sequelae.
🏥 DRG Assignment
MDC 03 — Diseases and Disorders of the Ear, Nose, Mouth and Throat
| DRG | Title | Est. Relative Weight* |
|---|---|---|
| DRG 157 | Dental and Oral Diseases with MCC | ~1.45 - 1.55 |
| DRG 158 | Dental and Oral Diseases with CC | ~0.95 - 1.05 |
| DRG 159 | Dental and Oral Diseases without CC/MCC | ~0.65 - 0.75 |
Approximate. Verify against IPPS FY2026 Final Rule tables5.
Sequencing and Complications
When a patient is admitted primarily for the surgical repair of the right mandibular fracture, S02.601A will sequence as the principal diagnosis. When admitted for a different primary trauma (e.g., polytrauma, ruptured spleen, or severe TBI), S02.601A sequenced as a secondary diagnosis acts as a Complication or Comorbidity (CC), potentially increasing the DRG weight and hospital reimbursement.
🔗 Related ICD-10-CM Codes
Laterality & Encounter Variants
| Code | Description |
|---|---|
| S02.601A | Fracture of unspecified part of body of right mandible, initial encounter for closed fracture ← This Code |
| S02.602A | Fracture of unspecified part of body of left mandible, initial encounter for closed fracture |
| S02.600A | Fracture of unspecified part of body of mandible, unspecified side, initial encounter for closed fracture |
Encounter and Healing Variants (Right Side)
| Code | Description |
|---|---|
| S02.601B | Fracture of unspecified part of body of right mandible, initial encounter for open fracture |
| S02.601D | Fracture of unspecified part of body of right mandible, subsequent encounter for fracture with routine healing |
| S02.601G | Fracture of unspecified part of body of right mandible, subsequent encounter for fracture with delayed healing |
| S02.601S | Fracture of unspecified part of body of right mandible, sequela |
🛠️ Commonly Associated CPT Codes (Oral & Maxillofacial / Trauma)
Outpatient and Profee Setting Context
Treatment of mandibular fractures often involves either closed manipulation or open surgical repair with internal fixation. The CPT code chosen depends on the approach and whether interdental fixation (wiring the jaws together) is required.
| CPT Code | Description | Profee Coding Notes (Modifier 26) |
|---|---|---|
| 21450 | Closed treatment of mandibular fracture; without manipulation | Used when the fracture requires only observation or soft diet instruction; carries a 90-day global period. |
| 21453 | Closed treatment of mandibular fracture with interdental fixation | Involves applying arch bars or wires to stabilize the jaw closed. |
| 21461 | Open treatment of mandibular fracture; without interdental fixation | The surgeon makes an incision (oral or external) to expose and plate the right fracture. |
| 21462 | Open treatment of mandibular fracture; with interdental fixation | Open reduction internal fixation (ORIF) combined with wiring the jaws together. |
NCCI Bundling Considerations
- Modifier -57 (Decision for Surgery): If the initial ED or office E/M visit results in the decision to perform major surgery (90-day global) on the same or next day, append modifier -57 to the E/M code to prevent it from being bundled into the surgical package.
🔬 ICD-10-PCS Crosswalk (Inpatient Procedures)
When S02.601A is an inpatient diagnosis, these PCS codes are relevant for associated inpatient procedures.
| PCS Section | Body System | Root Operation | Clinical Application |
|---|---|---|---|
| 0 (Medical and Surgical) | N (Head and Facial Bones) | S (Reposition) | Moving the fractured right mandibular bone back to its normal anatomic location. Example: 0NSV04Z (Reposition Mandible with Internal Fixation Device, Open Approach). |
| 0 (Medical and Surgical) | N (Head and Facial Bones) | S (Reposition) | Example: 0NSV3ZZ (Reposition Mandible, Percutaneous Approach). |
💊 Coding Scenarios and Examples
Scenario 1 — ED / Outpatient Hospital: Initial Trauma Evaluation
Clinical Vignette: A 24-year-old male presents to the ED after being struck on the right side of his jaw during an altercation. He complains of right jaw pain and inability to bite down normally. A maxillofacial CT scan reveals a non-displaced fracture of the right mandibular body. The oral mucosa is examined and noted to be completely intact. The oral surgeon on call evaluates the patient, confirms a closed fracture, and determines surgery is not currently required. The patient is placed on a soft diet and instructed to follow up in 1 week.
CPT / HCPCS (Profee):
- 21450 — Closed treatment of mandibular fracture; without manipulation
- 99284-57 — Emergency department visit, moderate complexity. (Modifier -57 added because the surgical treatment 21450 carries a 90-day global period and the decision for care was made during this visit).
Principal Diagnosis:
- S02.601A — Fracture of unspecified part of body of right mandible, initial encounter for closed fracture (Diagnosis matches the closed, right-sided body fracture).
Scenario 2 — Inpatient: Surgical Repair and Sequencing
Clinical Vignette: A 45-year-old female is admitted after an ATV accident. She sustained a severe concussion with a brief loss of consciousness, as well as a displaced fracture of the right mandibular body. The maxillofacial surgeon takes her to the OR for an open reduction and internal fixation (ORIF) of the right mandible with arch bar placement.
Principal Diagnosis:
- S06.0X1A — Concussion with loss of consciousness of 30 minutes or less, initial encounter (Reason for observation/admission).
Secondary Diagnoses:
- S02.601A — Fracture of unspecified part of body of right mandible, initial encounter for closed fracture (Role — CC).
MS-DRG Assignment: Because the right mandibular fracture is sequenced as a secondary diagnosis, it acts as a Complication or Comorbidity (CC), which will shift the grouping to a higher-weighted DRG (e.g., MS-DRG 092 - Other Disorders of Nervous System with CC).
Scenario 3 — CDI Query: Clarifying Open vs. Closed
Clinical Vignette: A trauma admission note lists “fracture of the body of the right mandible, awaiting surgical repair.” The physical exam notes “intraoral laceration adjacent to the premolars at the fracture site,” but the final assessment simply states “Right mandibular fracture.”
Action / Outcome: The coder flags the chart for a CDI query because the exam indicates a mucosal breach, which changes the coding to an open fracture, but the final assessment does not specify it. The coder queries the provider: “Based on the intraoral laceration noted at the fracture site, please clarify if this right mandibular fracture should be classified as open or closed.”
Query Response: Provider updates the addendum to confirm: “Right mandibular body fracture, open.”
Corrected ICD-10-CM Coding:
- S02.601B — Fracture of unspecified part of body of right mandible, initial encounter for open fracture
⚠️ Coding Pitfalls and Tips
| Pitfall or Tip | |
|---|---|
| ❌ | Defaulting to Unspecified Laterality. Submitting an unspecified code (e.g., S02.600A) when the medical record clearly indicates “right” is a common compliance error that leads to denials. |
| ❌ | Missing the “Open” Designation. Facial bone fractures often breach the oral mucosa. If the provider notes “tooth involvement with mucosal tear at the fracture site,” it must be coded as an open fracture (7th character B)1. |
| ✅ | 7th Character D for Follow-Up. When the patient returns to the office after the initial emergency visit or surgery to have their wires checked or removed, transition the 7th character from A to D (e.g., S02.601D) to indicate a subsequent encounter for routine healing1. |
| ✅ | Query for Anatomic Specificity. The mandible has several parts (symphysis, body, angle, ramus, condyle). If the provider simply writes “right jaw fracture,” query to see if it is specifically a body fracture before defaulting to the general S02.609A (Unspecified fracture of right mandible)2. |
📚 Sources
1 CMS/NCHS. ICD-10-CM Official Guidelines for Coding and Reporting, FY2026.
2 American Association of Oral and Maxillofacial Surgeons (AAOMS). Coding and Billing Guidelines for Maxillofacial Trauma.
3 Lee, Y.H., et al. (2024). Epidemiology and Management of Mandibular Body Fractures. Journal of Oral and Maxillofacial Surgery, 82(4), 412-419.
4 CMS. 2025-2026 Medicare Advantage Risk Adjustment — CMS-HCC Model v28 ICD-10-CM Mappings.
5 CMS. IPPS Final Rule FY2026 — MS-DRG Definitions Manual v43. MDC 03 logic tables.
6 AMA. CPT Professional Edition 2026. Surgery / Musculoskeletal System.