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ICD-10 Guide
ICD-10 CodesS21.05

S21.05

Billable

Open bite of breast

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/23/2025

Code Description

ICD-10 S21.05 is a billable code used to indicate a diagnosis of open bite of breast.

Key Diagnostic Point:

An open bite of the breast is a type of traumatic injury characterized by a laceration or puncture wound that penetrates the skin and underlying tissues of the breast. This injury can occur due to various mechanisms, including animal bites, human bites, or sharp object injuries. The clinical presentation may include localized pain, swelling, and potential bleeding at the site of injury. Open bites can lead to complications such as infection, which may necessitate surgical intervention, especially if the wound is deep or involves underlying structures. In cases of significant trauma, associated injuries such as rib fractures, pneumothorax, or hemothorax may also be present, requiring comprehensive evaluation and management. The treatment approach typically involves wound care, possible antibiotic therapy, and monitoring for complications. In severe cases, surgical intervention may be required to repair damaged tissues or to address any associated thoracic injuries. Accurate coding of this condition is crucial for proper reimbursement and to reflect the severity of the injury in clinical documentation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential causes (animal bites, human bites, sharp objects)
  • Need for detailed documentation of associated injuries
  • Potential for complications requiring surgical intervention
  • Variability in clinical presentation and treatment approaches

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to note associated injuries or complications
  • Lack of follow-up documentation for treatment outcomes
  • Inconsistent coding of similar injuries

Specialty Focus

Medical Specialties

Emergency Medicine

Documentation Requirements

Detailed account of the injury mechanism, assessment of associated injuries, and treatment provided.

Common Clinical Scenarios

Patients presenting with bite wounds, trauma from sharp objects, or complex chest injuries.

Billing Considerations

Ensure thorough documentation of any thoracic injuries and the rationale for surgical interventions.

General Surgery

Documentation Requirements

Operative reports detailing the extent of the injury, surgical procedures performed, and post-operative care.

Common Clinical Scenarios

Surgical repair of open bite injuries, management of infections, and treatment of associated thoracic injuries.

Billing Considerations

Accurate coding of surgical procedures and any complications that arise during treatment.

Coding Guidelines

Inclusion Criteria

Use S21.05 When
  • According to ICD
  • CM guidelines, S21
  • 05 should be used when documenting an open bite of the breast
  • Coders must ensure that the documentation supports the diagnosis, including the mechanism of injury and any associated complications

Exclusion Criteria

Do NOT use S21.05 When
  • Exclusions include bites that do not penetrate the skin or involve underlying tissues

Related ICD-10 Codes

Related CPT Codes

12001CPT Code

Simple repair of superficial wounds

Clinical Scenario

Used for repair of an open bite wound on the breast.

Documentation Requirements

Document the size of the wound and the method of repair.

Specialty Considerations

Ensure that the procedure is linked to the diagnosis of open bite.

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 open bites, which enhances the accuracy of clinical documentation and reimbursement processes. This specificity helps in tracking injury patterns and outcomes more effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of injuries, including open bites, which enhances the accuracy of clinical documentation and reimbursement processes. This specificity helps in tracking injury patterns and outcomes more effectively.

Reimbursement & Billing Impact

reimbursement processes. This specificity helps in tracking injury patterns and outcomes more effectively.

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 an open bite and a laceration?

An open bite involves a puncture or laceration caused by a bite, while a laceration is a cut that may not involve skin penetration by teeth.