Fracture of medial orbital wall, right side, 7thB

This code signifies a traumatic break in the bone forming the inner wall of the right eye socket, where the skin and soft tissue are also compromised, exposing the fracture site. This is an initial encounter for treatment of this specific open fracture.

Apply this code for a patient presenting with a newly diagnosed open fracture of the right medial orbital wall requiring active treatment. Documentation should clearly state "open fracture," "right medial orbital wall," and indicate the initial phase of care.

• Ensure documentation specifies "open fracture" to differentiate from closed fractures (S02.831A).
• Verify laterality (right side) is clearly documented; separate codes exist for the left and bilateral medial orbital wall fractures.
• Confirm this is the initial encounter for active treatment; subsequent encounters for routine healing or complications will require different seventh characters.