Documenting and Coding Orbital Fracture

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.

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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 www.outsourcestrategies.com

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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 www.outsourcestrategies.com

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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 www.outsourcestrategies.com

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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 reimburse ment and

minimize denials.

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