S02.12 vs S02.85XS
S02.12 (Fracture of orbital roof) compared with S02.85XS (Fracture of orbit, unspecified, sequela), 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. S02.85XS 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. S02.85XS 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 | S02.85XSFracture of orbit, unspecified, sequela | |
|---|---|---|
| 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, sequela is a billable ICD-10-CM diagnosis code (S02.85S). |
| 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