S02.612A

🧬 ICD-10 CM S02.612A — Fracture Of Condylar Process Of Left Mandible, Initial Encounter For Closed Fracture

Billable Code Confirmed

ICD-10 CM S02.612A is a valid, billable 7-character ICD-10-CM code for FY2026. The 6th character 2 specifies the left side, and the 7th character A specifies 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

• ❌ S02.612 — 6-character header — missing the 7th character encounter and fracture type designator (A, B, D, G, K, S).
• ❌ S02.61 — 5-character header — missing laterality specificity and 7th character.

Always submit S02.612A (all 7 characters) when a closed fracture of the left mandibular condylar process is documented with active treatment/initial encounter.

Clinical Context: Anatomic Specificity (Condyle)

ICD-10-CM S02.612A captures a closed fracture specifically of the condylar process (the articulating head/neck of the mandible forming the temporomandibular joint). This must be carefully distinguished from fractures of the subcondylar region (S02.62-), the coronoid process (S02.63-), or the mandibular ramus (S02.67-).

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.

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🔍 Code Description

ICD-10 CM S02.612A classifies Fracture of condylar process of left mandible, initial encounter for closed fracture. This diagnosis code represents the initial phase of care (active treatment, such as emergency evaluation, maxillo-mandibular fixation, or surgical reduction) for a break in the left condylar process of the lower jaw, without an open wound communicating with the fracture¹.

The condylar process is the superior, posterior projection of the mandibular ramus that articulates with the mandibular fossa of the temporal bone to form the temporomandibular joint (TMJ). Fractures in this region are very common following blunt trauma to the chin (symphysis), as the force is transmitted along the jawline to the relatively fragile condylar neck. A “closed” fracture means the bone is broken but has not punctured the overlying facial skin or the internal oral mucosa/external auditory canal. The 7th character “A” indicates the patient is receiving active, initial treatment².

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🌳 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... ❌ Non-billable  
│ ├── S02.61 Fracture of [[S02.611A|Condylar Process Fracture Right Mandible]]ar process of mandible ❌ Non-billable  
│ │ │  
│ │ ├── S02.610 Fracture of condylar process of unspecified mandible ❌ Non-billable  
│ │ ├── S02.611 Fracture of condylar process of right mandible ❌ Non-billable  
│ │ └── S02.612 Fracture of condylar process of left mandible ❌ Non-billable  
│ │ │  
│ │ ├── S02.612A Fracture of condylar process of left mandible, initial encounter for closed fracture ◀ THIS CODE ✅ Billable  
│ │ └── S02.612B Fracture of condylar process of left mandible, initial encounter for open fracture ✅ Billable  
│ │  
│ └── S02.62 Subcondylar fracture of mandible ❌ Non-billable  
│  
└── S02.8 Other fractures of skull and facial bones ❌ Non-billable

Specificity Insight

Condylar fractures require precise coding. Because the condyle is situated deep to the parotid gland and facial nerve, surgical approach (and therefore CPT coding) differs significantly from fractures of the anterior mandibular body. Ensure the diagnosis code explicitly captures “condylar process” rather than an unspecified mandible fracture to support the medical necessity of specialized TMJ-area procedures.

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✅ Includes

The following clinical terms and scenarios map to S02.612A when documented:

• Closed fracture of the left condyle of the mandible
• Left mandibular condylar neck fracture
• Left mandibular condylar head fracture
• Intracapsular fracture of the left TMJ (mandibular side)
• Broken left jaw (condyle region) receiving active treatment

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❌ Excludes

Excludes 1 — Cannot Be Coded Simultaneously with S02.612A

Code	Description	Note
S02.92XA	Unspecified fracture of facial bones, initial encounter for closed fracture	Mutually exclusive. Code S02.612A provides greater anatomic specificity for a facial bone fracture and overrides the unspecified code.

Excludes 1 Violation Risk

Never report an unspecified facial bone or generic skull fracture code alongside a specific left mandibular condylar 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 a concussion or other intracranial injury alongside the left jaw fracture.
S02.64XA	Fracture of symphysis of mandible, initial encounter for closed fracture	A blow to the anterior chin frequently causes both a symphyseal fracture and bilateral or unilateral condylar fractures. Code both if present.

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📋 Clinical Overview

Anatomic Distinction: Condyle vs. Subcondyle

Providers often use terms interchangeably, but ICD-10 distinguishes the anatomic regions.

Feature	S02.612A — Condylar Process	S02.622A — Subcondylar
Location	The articulating head and the immediate neck within or just below the TMJ capsule.	Further down the ramus, below the neck, before the angle of the mandible.
Clinical Implication	Higher risk of TMJ ankylosis, hemarthrosis, and meniscus injury.	Often treated similarly but poses less direct threat to the joint capsule itself.
Surgical Approach	Preauricular or retromandibular approach; technically difficult due to facial nerve.	Retromandibular or intraoral approach.

CDI Query Trigger — Fracture Location Clarification

If a radiology report notes “fracture of the left superior ramus near the joint space,” but the clinical note just says “Left jaw fracture,” query the provider to specify whether the fracture involves the condylar process, subcondylar region, or coronoid process, as this drives distinct ICD-10-CM pathways.

Manifestations & Symptom Burden

Patients presenting with a left condylar process fracture typically demonstrate the following signs and symptoms³:

• Deviation on Opening: The jaw will deviate to the left (the side of the fracture) upon opening due to the loss of forward translational movement by the left lateral pterygoid muscle.
• malocclusion: Premature contact of the teeth on the left side, causing an open bite on the opposite (right) side.
• Preauricular Pain/Swelling: Tenderness directly in front of the left ear.
• Bleeding from Ear (rare but possible): If the condyle is driven backward, it can fracture the anterior wall of the external auditory canal. (Note: If this breaches the skin of the canal, it becomes an open fracture: S02.612B).

Coding Manifestations

The fracture code (S02.612A) is the primary diagnosis. You do not need to separately code symptoms like malocclusion or jaw deviation if they are routine manifestations of the acute fracture itself.

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💰 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

S02.612A does not map to an HCC under v28⁴. Acute fractures of the facial bones are considered short-term conditions and do not typically carry long-term risk adjustment weight.

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🏥 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 left condylar fracture, S02.612A will sequence as the principal diagnosis. When admitted for a different primary trauma (e.g., severe traumatic brain injury), S02.612A sequenced as a secondary diagnosis acts as a Complication or Comorbidity (CC), potentially increasing the DRG weight and hospital reimbursement.

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🔗 Related ICD-10-CM Codes

Laterality & Encounter Variants

Code	Description
S02.612A	Fracture of condylar process of left mandible, initial encounter for closed fracture ← This Code
S02.611A	Fracture of condylar process of right mandible, initial encounter for closed fracture
S02.612B	Fracture of condylar process of left mandible, initial encounter for open fracture
S02.612D	Fracture of condylar process of left mandible, subsequent encounter for fracture with routine healing

Anatomic Site Variants (Mandible)

Code	Description
S02.622A	Subcondylar fracture of left mandible, initial encounter for closed fracture
S02.632A	Fracture of coronoid process of left mandible, initial encounter for closed fracture
S02.602A	Fracture of unspecified part of body of left mandible, initial encounter for closed fracture

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🛠️ Commonly Associated CPT Codes (Oral & Maxillofacial / Trauma)

Outpatient and Profee Setting Context

Treatment of condylar fractures often ranges from conservative (soft diet) to closed reduction with Maxillomandibular Fixation (MMF/IMF), or Open Reduction and Internal Fixation (ORIF). The condyle has its own specific CPT code for open treatment due to the complexity of the TMJ approach.

CPT Code	Description	Profee Coding Notes (Modifier 26)
21450	Closed treatment of mandibular fracture; without manipulation	Used when the left condylar fracture requires only observation or soft diet instruction; 90-day global.
21453	Closed treatment of mandibular fracture with interdental fixation	Involves applying arch bars or wiring the jaws shut (MMF) to allow the condyle to heal in proper occlusion.
21465	Open treatment of mandibular condylar fracture	Specific code for open repair of the condyle (e.g., preauricular approach, plating the condylar neck).

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 package⁶.

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🔬 ICD-10-PCS Crosswalk (Inpatient Procedures)

When S02.612A is an inpatient diagnosis, these PCS codes are relevant for associated inpatient procedures. (Note: ICD-10-PCS does not have separate body part characters for the right vs. left mandible; both use character “V” for Mandible).

PCS Section	Body System	Root Operation	Clinical Application
0 (Medical and Surgical)	N (Head and Facial Bones)	S (Reposition)	Moving the fractured left condyle back to its normal location. Example: 0NSV04Z (Reposition Mandible with Internal Fixation Device, Open Approach).
0 (Medical and Surgical)	N (Head and Facial Bones)	S (Reposition)	Placing arch bars without opening the skin/mucosa. Example: 0NSV3ZZ (Reposition Mandible, Percutaneous Approach).

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💊 Coding Scenarios and Examples

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Scenario 1 — ED / Outpatient Hospital: Closed Treatment with IMF

Clinical Vignette: A 22-year-old male presents to the ED after a bicycle accident where he struck his chin on the pavement. He has severe pain in front of his left ear and his jaw shifts to the left when he tries to open his mouth. A maxillofacial CT reveals a closed, moderately displaced fracture of the left mandibular condylar neck, as well as a small laceration on the chin. The oral surgeon applies Erich arch bars and wires the patient into maxillomandibular fixation (MMF) to restore occlusion.

CPT / HCPCS (Profee):

• 21453 — Closed treatment of mandibular fracture with interdental fixation
• 12011 — Simple repair of superficial wounds of face; 2.5 cm or less (for chin laceration)
• 99284-57 — Emergency department visit, moderate complexity. (Modifier -57 added for the decision to perform the 90-day global procedure 21453).

Principal Diagnosis:

• S02.612A — Fracture of condylar process of left mandible, initial encounter for closed fracture

Secondary Diagnoses:

• S01.81XA — Laceration without foreign body of other part of head, initial encounter (for the chin laceration).

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Scenario 2 — Inpatient: Surgical Repair (ORIF)

Clinical Vignette: A 35-year-old female is admitted after an assault. She sustained a severely displaced left condylar head fracture that has resulted in a severe malocclusion and foreshortening of the ramus, preventing conservative management. The surgeon takes her to the OR, makes a preauricular incision to protect the facial nerve, reduces the condyle, and applies a micro-plate and screws across the left condylar neck.

Principal Diagnosis:

• S02.612A — Fracture of condylar process of left mandible, initial encounter for closed fracture (Reason for admission and surgery).

MS-DRG Assignment: Because the principal diagnosis is a facial fracture and an operating room procedure was performed (0NSV04Z), this will group to MDC 03 and DRG 129 (Major Head and Neck Procedures with CC/MCC) or DRG 130 (Major Head and Neck Procedures without CC/MCC), depending on secondary diagnoses.

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Scenario 3 — CDI Query: Clarifying Laterality and Open/Closed

Clinical Vignette: A trauma admission note lists “fracture of the condylar process of the mandible, awaiting ORIF.” The physical exam notes “bleeding from the left external auditory canal, CT shows the condylar head has breached the anterior wall of the ear canal.” The final assessment simply states “Condylar fracture.”

Action / Outcome: The coder flags the chart for a CDI query. First, laterality is missing in the assessment. Second, because the bone fractured into the ear canal, it constitutes an open fracture, not closed. The coder queries the provider: “Based on the exam noting a left-sided injury with a breach into the auditory canal, please clarify the laterality of the condylar fracture and whether it should be classified as open or closed.”

Query Response: Provider updates the addendum to confirm: “Left condylar process fracture, open.”

Corrected ICD-10-CM Coding:

• S02.612B — Fracture of condylar process of left mandible, initial encounter for open fracture

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⚠️ Coding Pitfalls and Tips

	Pitfall or Tip
❌	Defaulting to Unspecified Mandible. Submitting an unspecified mandible fracture code (e.g., S02.609A) when the medical record clearly indicates a “condylar” fracture is a compliance error that can lead to denials, especially when billing specialized CPT codes like 21465.
❌	Confusing Condyle with Subcondyle. Always read the imaging report. If the radiologist says “subcondylar,” do not use S02.612A. You must use the subcondylar specific code (S02.622A)1.
✅	Check the Chin. Because condylar fractures are often caused by blows to the chin, carefully review the imaging for a concurrent fracture of the symphysis (anterior midline of the jaw). If present, both the condylar and symphyseal fractures should be coded.
✅	7th Character D for Follow-Up. When the patient returns to the oral surgery office in 4 weeks to have their arch bars/wires removed, transition the 7th character from A to D (e.g., S02.612D) to indicate a subsequent encounter for routine healing1.

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📚 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 Chrcanovic, B.R. (2025). Trauma to the Temporomandibular Joint: Management of Condylar Fractures. Journal of Cranio-Maxillofacial Surgery, 53(2), 112-120.
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.