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ICD-10 Guide
ICD-10 CodesS21.059

S21.059

Billable

Open bite of unspecified breast

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

Code Description

ICD-10 S21.059 is a billable code used to indicate a diagnosis of open bite of unspecified 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 breast tissue is highly vascularized, making it susceptible to significant bleeding and infection. In cases of open bites, there is a risk of associated injuries, such as rib fractures or pneumothorax, particularly if the trauma is blunt or involves significant force. The management of an open bite may require thorough cleaning, debridement, and possibly surgical intervention to prevent complications such as abscess formation or systemic infection. Additionally, the presence of underlying thoracic injuries, such as hemothorax or cardiac injuries, must be assessed, especially in cases of significant trauma. Proper documentation of the mechanism of injury, extent of the wound, and any associated injuries is crucial for accurate coding and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential mechanisms of injury (e.g., animal bites, human bites)
  • Need for detailed documentation of associated injuries
  • Potential for complications requiring surgical intervention
  • Variability in clinical presentation and treatment protocols

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to document associated injuries or complications
  • Incorrect coding due to confusion with similar codes
  • Lack of clarity in treatment plans or surgical interventions

Specialty Focus

Medical Specialties

Emergency Medicine

Documentation Requirements

Detailed account of the injury mechanism, vital signs, and initial treatment provided.

Common Clinical Scenarios

Patients presenting with bite wounds, trauma from falls, or accidents involving sharp objects.

Billing Considerations

Ensure all associated injuries are documented, including any thoracic injuries.

General Surgery

Documentation Requirements

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

Common Clinical Scenarios

Surgical management of infected bite wounds or traumatic injuries requiring debridement.

Billing Considerations

Document any complications that arise during surgery or recovery.

Coding Guidelines

Inclusion Criteria

Use S21.059 When
  • According to ICD
  • 10 coding guidelines, S21
  • 059 should be used when the injury is specifically an open bite of the breast without further specification
  • Coders must ensure that the documentation supports the diagnosis and that any associated injuries are coded appropriately

Exclusion Criteria

Do NOT use S21.059 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

12001CPT Code

Simple repair of superficial wounds

Clinical Scenario

Used for repair of the open bite wound after initial assessment.

Documentation Requirements

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

Specialty Considerations

Emergency medicine and surgical specialties should ensure accurate coding based on the complexity of the repair.

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 helps in better tracking of trauma cases and associated complications.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of injuries, including open bites, which helps in better tracking of trauma cases and associated complications.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of injuries, including open bites, which helps in better tracking of trauma cases and associated complications.

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 closed wound?

An open bite involves a break in the skin with potential exposure of underlying tissues, while a closed wound does not penetrate the skin and typically involves bruising or contusion.