S02.12 vs S02.85XK
S02.12 (Fracture of orbital roof) compared with S02.85XK (Fracture of orbit, unspecified, subsequent encounter for fracture with nonunion), from the official CMS tabular data. Do not report these codes together: the official tabular list marks them Excludes1.
Can these codes be reported together?
No — do not report together. S02.85XK carries an Excludes1 note covering S02.12: “orbital roof (S02.12-)”
Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).
Yes, when both are documented. S02.85XK carries an Excludes2 note covering S02.12: “fracture of orbital roof (S02.12-)”
Excludes2 marks distinct conditions — both may be reported when both are documented.
Side by side
| S02.12Fracture of orbital roof | S02.85XKFracture of orbit, unspecified, subsequent encounter for fracture with nonunion | |
|---|---|---|
| Billing status | Non-billable header Report instead: S02.121A, S02.121B, S02.121D, S02.121G, S02.121K | Billable |
| Classification | S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) | S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) |
| Definition | Fracture of orbital roof is a non-billable ICD-10-CM category code (S02.12). | Fracture of orbit, unspecified, subsequent encounter for fracture with nonunion is a billable ICD-10-CM diagnosis code (S02.85K). |
| 7th character | The appropriate 7th character is to be added to each code from category S02 | The appropriate 7th character is to be added to each code from category S02 |
| Includes | injuries of ear injuries of eye injuries of face [any part] injuries of gum | injuries of ear injuries of eye injuries of face [any part] injuries of gum |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources