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ICD-10 Guide
ICD-10 CodesS01.1

S01.1

Billable

Open wound of eyelid and periocular area

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 S01.1 is a billable code used to indicate a diagnosis of open wound of eyelid and periocular area.

Key Diagnostic Point:

An open wound of the eyelid and periocular area refers to a laceration or break in the skin surrounding the eye, which can result from various mechanisms such as trauma, surgical procedures, or accidents. These wounds can be classified as superficial or deep, depending on the extent of tissue damage. Common causes include blunt or sharp trauma, animal bites, or foreign body injuries. Clinically, these wounds may present with bleeding, swelling, and potential exposure of underlying structures, including muscles and nerves. The eyelid's unique anatomy necessitates careful assessment to prevent complications such as scarring, eyelid malposition, or functional impairment. Diagnosis typically involves a thorough history and physical examination, often supplemented by imaging if deeper structures are suspected to be involved. Management may include wound cleaning, suturing, and, in some cases, referral to an ophthalmologist for specialized care. Complications can include infection, delayed healing, and cosmetic concerns, making accurate coding essential for appropriate treatment and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in injury mechanisms (e.g., blunt vs. sharp trauma)
  • Need for precise documentation of wound depth and extent
  • Potential for associated injuries to the eye or surrounding structures
  • Differentiation from similar codes for other facial injuries

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the depth of the wound
  • Misclassification of the injury type (e.g., open vs. closed)
  • Lack of follow-up documentation for complications

Specialty Focus

Medical Specialties

Emergency Medicine

Documentation Requirements

Documentation must include a detailed description of the injury, mechanism of injury, and initial treatment provided.

Common Clinical Scenarios

Trauma cases involving lacerations from falls, sports injuries, or assaults.

Billing Considerations

Ensure that all relevant details about the injury and treatment are captured to support the coding.

Surgery

Documentation Requirements

Operative reports must detail the surgical approach, techniques used, and any complications encountered.

Common Clinical Scenarios

Surgical repair of eyelid lacerations or reconstruction following trauma.

Billing Considerations

Accurate coding requires clear documentation of the surgical procedure and any associated diagnoses.

Coding Guidelines

Inclusion Criteria

Use S01.1 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code accurately reflects the specific type and location of the injury
  • Document the mechanism of injury and any associated conditions

Exclusion Criteria

Do NOT use S01.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

12001CPT Code

Simple repair of superficial wounds of the face, ears, eyelids, and scalp

Clinical Scenario

Used when performing a simple repair of an eyelid laceration.

Documentation Requirements

Document the size of the wound, location, and repair technique used.

Specialty Considerations

Ensure that the procedure is linked to the appropriate diagnosis code.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of injuries, including those of the eyelid and periocular area, improving the accuracy of claims and facilitating better patient care.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of injuries, including those of the eyelid and periocular area, improving the accuracy of claims and facilitating better patient care.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of injuries, including those of the eyelid and periocular area, improving the accuracy of claims and facilitating better patient care.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between S01.1 and S01.00?

S01.1 is used for open wounds of the eyelid and periocular area, while S01.00 is for unspecified open wounds of the eyelid. It's important to specify the location and type of wound for accurate coding.