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In today’s podcast, Natalie Tornese, one of our Senior Solutions Managers will discuss Orbital Fracture, a common eye condition and its ICD-10 codes.

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Hello everyone and welcome to our podcast series!

My name is Natalie Tornese and I’m a Senior Solutions Manager at Outsource Strategies International (OSI). Wanted to talk a little bit about Orbital Fractures.

Orbital fractures occur 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 up of a fairly hard, thick bone 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 prompt to breaking. A fracture is a broken bone in the 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 problems with vision or involving double vision as well.

Men suffer from traumatic eye injuries about four times more often than women. It is estimated that the average age of the injured person is 30 years old. In most cases, orbital fractures are caused by blunt force trauma, motor vehicle accidents and sometimes even physical assaults.

Orbital fractures can affect any of the bones surrounding the eye. There are three different types -

Orbital rim fracture, which is often caused by car accidents 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.

The blowout fracture is the type of fracture that 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 is an injury that occurs when a blow or trauma to the orbital rim pushes the bones back, causing the bones of the eye socket floor to buckle in a downward direction. 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.

 

(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
  • 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

S02.32 - Fracture of orbital floor, left side

  • 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)

The orbital trapdoor fracture is a very rare condition that generally occurs in children. It is defined as a minimally displaced fracture of the orbital floor that has spontaneously reduced to its original position incarcerating an extra ocular muscle.The main symptom of a broken eye socket is pain. In most cases, the signs and symptoms will vary and depend on the type of fracture and the severity of the injury.

Common signs and symptoms are –

  • Blurred vision, decreased or double vision
  • Swollen skin under the eye
  • Swelling of the forehead or cheek
  • Numbness on the injured side of the face
  • Intense cheek pain when opening the mouth
  • Difficulty moving the eye to look left, right, up or down
  • Bulging or sunken eyeballs
  • Blood in the white part of the eye and
  • Black and blue bruising around the eyes

In order to make an initial diagnosis, ophthalmologists may physically inspect the eye and the surrounding area. They may also check eye pressure and ask patients questions about their vision level, as such as whether they can look in all directions. They might measure the eye to see if it is positioned properly in the eye socket. And they may do imaging tests like X-rays, CT scans to perform the diagnosis.

Treatment for eye conditions in most cases depend on the severity of the injury and the symptoms the patients experiencing. Orbital fracture 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 treatment options that may include pain relief medications and oral antibiotics to prevent infection. They also may 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 recommend additional tips to make people more relaxed, while it heals. Recovery tips include -

  • Sleeping with your head elevated
  • Applying a gel pack to the area (every 3-4 hours) to reduce swelling
  • Avoid straining, coughing, sneezing
  • Being careful not to strain while lifting or pushing a heavy object and
  • Consuming over-the-counter pain medications like ibuprofen or Tylenol as directed

Generally, the swelling and bruising symptoms associated with the condition may show visible improvements within a week or two. The fracture, however can take a much longer time to completely heal. The recovery time period may directly depend on the severity of the fracture and the intensity of infection or other related complications.

If any of these treatment modalities do not yield the desired results, then surgery will be considered as a last option. Surgery for a broken eye socket can be risky. The purpose of the surgery is to restore the orbit to its original status before the injury. 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 type of fracture, the surgical procedures may include – restructuring eye socket, removing bone fragments, freeing trapped muscles, ligaments, or nerves and repairing deformities.

I will include a transcript along with this podcast outlining the ICD-10 codes related to coding these fractures.

Patients experiencing symptoms of an orbital fracture should immediately seek medical attention. It is not always possible to prevent the occurrence of accidents, but taking adequate preventive measures can help protect the eyes, face and may reduce the chances of injuring the eye socket in the long run. All these possible preventive steps can include -

  • Wearing protective eyewear
  • Wearing a seatbelt
  • Wearing a protective mask when playing ball
  • Using protective goggles when shooting firearms or working with explosives or any pressurized items and
  • Keeping the head against the headrest and far from the airbag while driving

I hope this helps. But always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for listening!