An orbital fracture occurs when there is a break in one of the bones surrounding the eyeball. The article provides an overview of the condition along with the ICD-10 codes.

1. Documenting
and Coding
Orbital
Fracture
An orbital fracture occurs when there is a break in one of the bones
surrounding the eyeball. The article provides an overview of the condition
along with the ICD-10 codes.
Outsource Strategies International
United States

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An orbital fracture occurs when one or more of the bones around the
eye ball (called the orbit, or eye socket) break. The orbit refers to the
group of bones that surround the eyeball, making up the eye socket.
This is generally formed by seven different bones that fuse together to
form a solid ’cup’ within the skull. The eye socket is a bony structure
that surrounds and protects the eye. Besides the eye, it houses all the
muscles, nerves, and connective tissues that connect to and move the
eye. The rim of the eye socket is made of fairly hard, thick bones and
is difficult to break. On the other hand, the floor and nasal side of the
socket is quite thin in many places and is more to breaking. A fracture
is a broken bone in the eye socket involving the rim, the floor or both.
If left untreated, the condition can make the eye muscles to get
trapped, making it difficult to even move the eye and causing serious
problem with vision or involving double vision as well.
Ophthalmologists or other eye specialists dealing with patients
suffering from orbital fracture need to know the ICD-10 codes to
report this condition correctly. Opting for billing services from a
reliable and established ophthalmology medical billing company
would help in accurate and timely claim filing for appropriate
reimbursement.
Reports suggest that men suffer from traumatic eye injuries about four
times more often than women do. It is estimated that the average age
of the injured person is 30 years. In most cases, orbital fractures are
caused by blunt force trauma, when something hits the eye hard like –
motor vehicle accidents (such as falling from a height or having a car
accident), physical assaults and fighting (punch or kick to the eye) and
sports related injuries (like hitting cricket ball to the eye). Using tools
such as hammers, drills, and power saws may also increase a person's
risk of eye injuries.
Types of Orbital Fractures
Orbital fractures can affect any of the bones surrounding the eye.
There are three different types of orbital fractures -

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 Orbital rim fracture – Often caused by car accidents, this
fracture affects the thick bony outer edges of the eye socket.
People suffering from this type of fracture are more likely to have
other injuries to the face, and possibly the optic nerve.
 Blowout fracture – This type of fracture is a break of the thin
inner wall or floor of the eye socket. People who get hit with a
baseball or fist in their eye often cause these breaks.
 Orbital floor fracture – This eye injury occurs when a blow or
trauma to the orbital rim pushes the bones back, causing the
bones of the eye socket floor buckle to downward direction. In
addition, this fracture also affects the muscles and nerves around
the eye, keeping it from moving properly or feeling normal. In
elderly people, these breaks may occur due to a fall that causes
their cheek to hit a piece of furniture or other hard surface.
 Orbital trapdoor fracture – Considered as a very rare condition
that generally occur in children, this is defined as a minimally
displaced fracture of the orbital floor that has spontaneously
reduced to its original position incarcerating an extra ocular
muscle.
What Are the Signs and Symptoms?
The main symptom of a broken eye socket is pain around the eye. In
most cases, the signs and symptoms of an orbital fracture will vary
and depend on the type of fracture and the severity of the injury.
Common signs and symptoms include –
 Blurred, decreased or double vision
 Swollen skin under the eye
 Swelling of the forehead or cheek
 Numbness in the injured side of the face
 Intense cheek pain when opening the mouth
 Flattened cheek
 Difficulty moving the eye to look left, right, up or down
 Bulging or sunken eyeballs
 Blood in the white part of the eye
 Black and blue bruising around the eyes

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How Is an Orbital Fracture Diagnosed and Treated?
In order to make an initial diagnosis of an orbital fracture,
ophthalmologists may physically inspect the eye and the surrounding
areas. They may also check eye pressure and ask patients questions
about their vision level, such as whether they can look in all directions.
They might also measure the eye to see if it is positioned properly in
the eye socket. Imaging tests like X-rays and CT scans will be
performed to confirm the diagnosis.
The treatment for this eye condition in most cases may depend on the
severity of the injury and the symptoms patients may be experiencing.
Orbital fractures treatment modalities may include conservative as well
as surgical techniques. If the symptoms are minor and the broken eye
sockets can heal naturally, eye specialists may recommend
complementary treatment options involving pain relief medications and
possibly oral antibiotics to prevent infection. Ophthalmologists may
also recommend special nasal sprays for patients to avoid sneezing or
blowing their nose while the eye socket is healing. Sneezing or blowing
the nose can put unnecessary pressure on the fractured area and may
spread bacteria from the sinuses to the injured eye socket.
Eye specialists may also recommend additional tips to make people
more relaxed, while the eye socket heals. These recovery tips include -
 Sleeping with your head elevated on extra pillows
 Applying an ice/gel pack to the area (every 3-4 hours) to reduce
swelling during the first 48 hours
 Avoiding straining, coughing, sneezing
 Taking care not to strain while lifting, pushing a heavy object, or
having a bowel movement
 Consuming over-the-counter (OTC) pain medications, such as
ibuprofen (Advil) or acetaminophen (Tylenol) as directed by the
eye specialist
Generally, the swelling and bruising symptoms associated with the
condition may show visible improvements within a week or two, the
fracture can take a much longer time to completely heal. The recovery

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time period may directly depend on the severity of the fracture and
intensity of infections or other related complications. Some of the
possible complications include - double vision, loss of vision, nerve
damage (resulting in altered sensation to the cheek), sunken eye (the
eyeball sits deeper in the eye socket), drooping of the lower eye lid
and a break in the bone between the eye and sinuses.
If any of the above treatment modalities does not yield the desired
results, surgery will be considered as a last option. Surgery for a
broken eye socket can be a risky option. The purpose of surgery is to
restore the orbit to its original status before injury. However, if the
surgery is absolutely necessary, the surgeon may wait for a few weeks
until the swelling in the eye reduces completely. A reconstructive
surgeon who deals with eye injuries may perform the surgery.
Depending on the specific type of fracture, the surgical procedures
may include – restructuring the eye socket, removing bone fragments,
freeing trapped muscles, ligaments, or nerves and repairing
deformities.
ICD-10 Coding
The diagnostic tests and treatment procedures for orbital fractures
performed by ophthalmologists or other eye specialists must be
correctly documented using the right codes. An experienced medical
billing and coding company can help physicians report the correct
billing codes. ICD-10 codes for Orbital Fracture include –
S02 Fracture of skull and facial bones
S02.19 - Other fracture of base of skull
 S02.19XA - Other fracture of base of skull, initial encounter for
closed fracture
 S02.19XB - Other fracture of base of skull, initial encounter for
open fracture
 S02.19XD - Other fracture of base of skull, subsequent encounter
for fracture with routine healing

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 S02.19XG - Other fracture of base of skull, subsequent encounter
for fracture with delayed healing
 S02.19XK - Other fracture of base of skull, subsequent encounter
for fracture with nonunion
 S02.19XS - Other fracture of base of skull, sequela
S02.3 Fracture of orbital floor
S02.30 Fracture of orbital floor, unspecified side
 S02.30XA - Fracture of orbital floor, unspecified side, initial
encounter for closed fracture
 S02.30XB - Fracture of orbital floor, unspecified side, initial
encounter for open fracture
 S02.30XD - Fracture of orbital floor, unspecified side, subsequent
encounter for fracture with routine healing
 S02.30XG - Fracture of orbital floor, unspecified side, subsequent
encounter for fracture with delayed healing
 S02.30XK - Fracture of orbital floor, unspecified side, subsequent
encounter for fracture with nonunion
 S02.30XS - Fracture of orbital floor, unspecified side, sequela
S02.31 Fracture of orbital floor, right side
 S02.31XA - Fracture of orbital floor, right side, initial encounter for
closed fracture
 S02.31XB - Fracture of orbital floor, right side, initial encounter for
open fracture
 S02.31XD - Fracture of orbital floor, right side, subsequent
encounter for fracture with routine healing
 S02.31XG - Fracture of orbital floor, right side, subsequent
encounter for fracture with delayed healing
 S02.31XK - Fracture of orbital floor, right side, subsequent
encounter for fracture with nonunion
 S02.31XS - Fracture of orbital floor, right side, sequela
S02.32 - Fracture of orbital floor, left side

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 S02.32XA - Fracture of orbital floor, left side, initial encounter for
closed fracture
 S02.32XB - Fracture of orbital floor, left side, initial encounter for
open fracture
 S02.32XD - Fracture of orbital floor, left side, subsequent encounter
for fracture with routine healing
 S02.32XG - Fracture of orbital floor, left side, subsequent encounter
for fracture with delayed healing
 S02.32XK - Fracture of orbital floor, left side, subsequent encounter
for fracture with nonunion
 S02.32XS - Fracture of orbital floor, left side, sequela
Coding Orbital Fractures with Improved Clarity in 2020
Starting to be effective from October 2019, ophthalmology coders will
be able to report orbital roof and wall fractures with the most
specificity as several new ICD-10-CM code categories will be added.
Presently, there is only one diagnosis code, S02.3- Fracture of orbital
floor, to report orbital bone fractures, and only one diagnosis code,
S02.19 - Other fracture of base of skull, to report orbital roof
fractures. However, there is no code that allows you to specify which
of the other three walls of the orbit (roof, medial wall, and temporal
wall) are injured.
The 2020 ICD-10-CM code book will comprise several new codes (and
tabular modifications to accommodate the new codes) that more
clearly identify orbital fractures. Under new subcategory S02.12 -
Fracture of orbital roof, new codes will be added –
 S02.121 - Fracture of orbital roof, right side
 S02.122 - Fracture of orbital roof, left side
 S02.129 - Fracture of orbital roof, unspecified side
Under new subcategory S02.83 - Fracture of medial orbital wall, new
codes include –
 S02.841 - Fracture of lateral orbital wall, right side

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 S02.842 - Fracture of lateral orbital wall, left side
 S02.849 - Fracture of lateral orbital wall, unspecified side
Under category S02.8 - Fractures of other specified skull and facial
bones, is one new code –
 S02.85 - Fracture of orbit, unspecified
To the above fracture codes, add the appropriate seventh character to
indicate encounter type -
 A – Initial encounter for closed fracture
 B – Initial encounter for open fracture
 D – Subsequent encounter for fracture with routine healing
 G – Subsequent encounter for fracture with delayed healing
 K – Subsequent encounter for fracture with nonunion
 S – Sequela
For S02.85 - add a placeholder X in the sixth character position.
The above listed category expansion and consequential tabular
modifications are based on a proposal by the American Academy of
Ophthalmology at the ICD-10 Coordination and Maintenance
Committee Meeting held Sept. 12, 2018.
How to Prevent Orbital Fractures
Patients experiencing symptoms of an orbital fracture should
immediately seek medical attention. As it is always not possible to
prevent the occurrence of accidents, taking adequate preventive
measures can help protect the eyes and face and may reduce the
chances of injury to the eye socket in the long run. Possible preventive
steps include -
 Wearing protective eyewear when doing house repairs
 Wearing a seatbelt in the car
 Wearing a protective mask when playing ball sports

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 Using protective goggles when shooting firearms or working with
explosives or pressurized items
 Keeping the head against the headrest and far from the airbag
while driving
Knowledge of medical billing and coding requirements is important to
report diagnosis and treatment of different types of orbital fractures.
Partnering with established medical billing outsourcing companies
can help to submit accurate claims to improve the reimbursement and
minimize denials.