October 12, 2022

Coding pneumothorax and rib fractures has often been a pain point for many. Confusion surrounding which codes to assign, when to assign them and what the proper documentation is cause uncertainty for many. Below, we’ve outlined several examples to help eliminate the confusion and provide a clear course of action.

S22.41XA is assigned for multiple fractures of ribs on the right side.

S27.0XXA is assigned for the traumatic pneumothorax.

ICD-10-CM Official Guidelines for Coding and Reporting

Section I. Conventions, general coding guidelines and chapter-specific guidelines

C. Chapter-Specific Coding Guidelines

19. Chapter 19: Injury, poisoning, and certain other consequences of external causes

B. Coding of Injuries:

When coding injuries, assign separate codes for each injury unless a combination code is provided, in which case the combination code is assigned.

The code for the most serious injury, as determined by the provider and the focus of treatment, is sequenced first.


ICD-10-CM Official Guidelines for Coding and Reporting

Section II. Selection of Principal Diagnosis

Part B:  Two or more interrelated conditions, each potentially meeting the definition for principal diagnosis:

When there are two or more interrelated conditions (such as diseases in the same ICD-10-CM chapter or manifestations characteristically associated with a certain disease) potentially meeting the definition of principal diagnosis, either condition may be sequenced first, unless the circumstances of the admission, the therapy provided, the Tabular List or the Alphabetic Index indicates otherwise.


Based on these guidelines, it would at first appear that either condition could be sequenced first if the provider does not specify or indicate which was more severe. However, in the codebook under category S22, Fracture of rib(s), sternum and thoracic spine, there is a code first note.

“Code First any associated: injury of an intrathoracic organ (S27.-) or spinal cord injury (S24.0-, S24.1-)”.

In this case, pneumothorax would be the principal diagnosis based on the Code First note under S22.

Coding multiple injuries can be tricky. Make sure to check all instructional notes when reporting and sequencing codes for traumatic injuries.



Alicia R. Blamble, RHIA

Managing Auditor, Excite Health Partners


Lisa Marks, RHIT, CCS

VP of HIM, Excite Health Partners