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S02.11AB ICD-10-CM Code: Type I occipital condyle fracture, right side, initial encounter for open fracture

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, Appendix B.

  • MS-DRG 082 — TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC (MDC 01)
  • MS-DRG 083 — TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC (MDC 01)
  • MS-DRG 084 — TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC (MDC 01)
  • MS-DRG 085 — TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC (MDC 01)
  • MS-DRG 086 — TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC (MDC 01)
  • MS-DRG 087 — TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC (MDC 01)
  • MS-DRG 963 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC (MDC 24)
  • MS-DRG 964 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC (MDC 24)
  • MS-DRG 965 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC (MDC 24)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 399 — Major Head Injury without Loss of Consciousness

Other models: CMS-HCC V22 HCC 167

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Official Registry Overview & Definition

Type I occipital condyle fracture, right side, initial encounter for open fracture is a billable ICD-10-CM diagnosis code (S02.11AB).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for S02.11AB in the official ICD-10-CM tabular list.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • injuries of ear
  • injuries of eye
  • injuries of face [any part]
  • injuries of gum
  • injuries of jaw
  • injuries of oral cavity
  • injuries of palate
  • injuries of periocular area
  • injuries of scalp
  • injuries of temporomandibular joint area
  • injuries of tongue
  • injuries of tooth

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Code Also

Additional codes that may be required to fully describe the encounter.

  • any associated intracranial injury (S06.-)
  • for any associated infection

Frequently Compared Codes

The official Excludes notes on S02.11AB name these codes. Each comparison page covers when the two can — or must not — be reported together.

Change history

  • FY2017 — 2016-10-01
    Added to the code set
    Type I occipital condyle fracture, right side, initial encounter for open fracture
    FY2017 changes

Verify Before Coding

  • MCC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim.

Contextual Map

Every relationship of S02.11AB in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

  • S00-T88 — Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) (S00-T88) [Hierarchy]
  • S00-S09 — Injuries to the head [Hierarchy]

Referenced by Excludes1 notes

  • S01 — Open wound of head [Excludes1](via S02.-): “open skull fracture (S02.- with 7th character B)” · check together

Referenced by Excludes2 notes

  • S02.3 — Fracture of orbital floor [Excludes2](via S02.1.-): “orbital roof (S02.1-)” · check together
  • S05 — Injury of eye and orbit [Excludes2](via S02.1.-): “orbital bone fracture (S02.1-, S02.3-, S02.8-)” · check together

Referenced by Code First instructions

Referenced by Use Additional Code instructions

  • S07 — Crushing injury of head [Use Additional Code](via S02.-): “skull fractures (S02.-)” · check together

Referenced by Code Also instructions

  • S04 — Injury of cranial nerve [Code Also](via S02.-): “skull fracture (S02.-)” · check together
  • S06 — Intracranial injury [Code Also](via S02.-): “skull fracture (S02.-)” · check together

Clinical classification (CCSR)

  • INJ001 — Fracture of head and neck, initial encounter [CCSR]

Risk adjustment (CMS-HCC)

  • HCC 399 — Major Head Injury without Loss of Consciousness [CMS-HCC]

Potential MS-DRG (9)

  • MCC — Major Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (MCC).”
  • DRG 082 — TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC [MS-DRG]: “TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC (MDC 01)”
  • DRG 083 — TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC [MS-DRG]: “TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC (MDC 01)”
  • DRG 084 — TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC [MS-DRG]: “TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC (MDC 01)”
  • DRG 085 — TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC [MS-DRG]: “TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC (MDC 01)”
  • DRG 086 — TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC [MS-DRG]: “TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC (MDC 01)”
  • DRG 087 — TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC [MS-DRG]: “TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC (MDC 01)”
  • DRG 963 — OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC [MS-DRG]: “OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC (MDC 24)”
  • and 2 more

MDC crossing · procedures (31849)

  • MDC 01 — Diseases and Disorders of the Nervous System [MDC crossing]: “Diseases and Disorders of the Nervous System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • MDC 24 — Multiple Significant Trauma [MDC crossing]: “Multiple Significant Trauma — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • 0016070 — Bypass Cerebral Ventricle to Nasopharynx with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Nasopharynx with Autologous Tissue Substitute, Open Approach — grouped in MDC 01, the procedure side of this code's crossing.” · check together
  • 0016071 — Bypass Cerebral Ventricle to Mastoid Sinus with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Mastoid Sinus with Autologous Tissue Substitute, Open Approach — grouped in MDC 01, the procedure side of this code's crossing.” · check together
  • 0016072 — Bypass Cerebral Ventricle to Atrium with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Atrium with Autologous Tissue Substitute, Open Approach — grouped in MDC 01, the procedure side of this code's crossing.” · check together
  • 0016073 — Bypass Cerebral Ventricle to Blood Vessel with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Blood Vessel with Autologous Tissue Substitute, Open Approach — grouped in MDC 01, the procedure side of this code's crossing.” · check together
  • 0016074 — Bypass Cerebral Ventricle to Pleural Cavity with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Pleural Cavity with Autologous Tissue Substitute, Open Approach — grouped in MDC 01, the procedure side of this code's crossing.” · check together
  • and 31844 more

Nearest codes (40)

  • S02 — Fracture of skull and facial bones [Sibling]
  • S02.113D — Unspecified occipital condyle fracture, subsequent encounter for fracture with routine healing [Sibling]
  • S02.113G — Unspecified occipital condyle fracture, subsequent encounter for fracture with delayed healing [Sibling]
  • S02.113K — Unspecified occipital condyle fracture, subsequent encounter for fracture with nonunion [Sibling]
  • S02.113S — Unspecified occipital condyle fracture, sequela [Sibling]
  • S02.118 — Other fracture of occiput, unspecified side [Sibling]
  • S02.118A — Other fracture of occiput, unspecified side, initial encounter for closed fracture [Sibling]
  • S02.118B — Other fracture of occiput, unspecified side, initial encounter for open fracture [Sibling]
  • and 32 more

Change history

  • FY2017 — Added to the code set [Change history]

Referenced by Other Codes

Clinical classification (AHRQ CCSR):INJ001 — Fracture of head and neck, initial encounter (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Potential MS-DRG Relationships (FY2026)

MCC — Major Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 383 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 9 MS-DRGs: DRG 082 (MDC 01), DRG 083 (MDC 01), DRG 084 (MDC 01), DRG 085 (MDC 01), DRG 086 (MDC 01), DRG 087 (MDC 01), DRG 963 (MDC 24), DRG 964 (MDC 24), DRG 965 (MDC 24).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Official ICD-10-CM tabular notes on other codes that name S02.11AB or its code family.

1 Excludes1 notes: S01 (via S02.-).

2 Excludes2 notes: S02.3 (via S02.1.-), S05 (via S02.1.-).

1 Code First instructions: R40.2 (via S02.-).

1 Use Additional Code instructions: S07 (via S02.-).

2 Code Also instructions: S04 (via S02.-), S06 (via S02.-).

Frequently Asked Questions (FAQ) & Clinical Guidance

Does S02.11AB require a 7th character?

Yes. The appropriate 7th character is to be added to each code from category S02.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to S02.11AB in its code family, with their registry titles.

  • S02.119G — Unspecified fracture of occiput, subsequent encounter for fracture with delayed healing
  • S02.119K — Unspecified fracture of occiput, subsequent encounter for fracture with nonunion
  • S02.119S — Unspecified fracture of occiput, sequela
  • S02.11A — Type I occipital condyle fracture, right side
  • S02.11AA — Type I occipital condyle fracture, right side, initial encounter for closed fracture
  • S02.11AD — Type I occipital condyle fracture, right side, subsequent encounter for fracture with routine healing
  • S02.11AG — Type I occipital condyle fracture, right side, subsequent encounter for fracture with delayed healing
  • S02.11AK — Type I occipital condyle fracture, right side, subsequent encounter for fracture with nonunion
  • S02.11AS — Type I occipital condyle fracture, right side, sequela
  • S02.11B — Type I occipital condyle fracture, left side

View all codes in the S02 family