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ICD-10 Guide
ICD-10 CodesS21.159

S21.159

Billable

Open bite of unspecified front wall of thorax without penetration into thoracic cavity

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

Code Description

ICD-10 S21.159 is a billable code used to indicate a diagnosis of open bite of unspecified front wall of thorax without penetration into thoracic cavity.

Key Diagnostic Point:

An open bite of the front wall of the thorax refers to a traumatic injury where a portion of the thoracic wall is disrupted, typically due to a bite from an animal or human. This injury does not penetrate the thoracic cavity, meaning that vital structures such as the lungs, heart, and major blood vessels remain intact. Clinically, patients may present with localized pain, swelling, and potential soft tissue injury. While rib fractures may occur in conjunction with this type of injury, they are not a direct result of the open bite itself. The absence of penetration into the thoracic cavity is crucial, as it significantly reduces the risk of complications such as pneumothorax (air in the pleural space) or hemothorax (blood in the pleural space). Management typically involves wound care, pain management, and monitoring for any signs of infection or complications. Surgical intervention is rarely required unless there are associated injuries or complications. Accurate coding is essential for proper treatment documentation and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between open and closed injuries
  • Identifying associated injuries such as rib fractures
  • Understanding the implications of non-penetrating injuries
  • Documenting the mechanism of injury accurately

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the nature of the bite (animal vs. human)
  • Misreporting associated injuries like rib fractures
  • Inconsistent coding practices across providers

Specialty Focus

Medical Specialties

Emergency Medicine

Documentation Requirements

Detailed account of the injury mechanism, physical examination findings, and any imaging results.

Common Clinical Scenarios

Patients presenting with bite wounds, chest pain, or respiratory distress.

Billing Considerations

Ensure that the documentation clearly states the absence of thoracic cavity penetration.

Trauma Surgery

Documentation Requirements

Comprehensive surgical notes if intervention is required, including any associated injuries.

Common Clinical Scenarios

Management of complex chest trauma cases with potential surgical intervention.

Billing Considerations

Document any surgical findings and the rationale for intervention to support coding.

Coding Guidelines

Inclusion Criteria

Use S21.159 When
  • Follow ICD
  • CM guidelines for coding injuries, ensuring that the specific nature of the injury is documented

Exclusion Criteria

Do NOT use S21.159 When
  • Exclude codes for penetrating injuries or those involving the thoracic cavity

Related ICD-10 Codes

Related CPT Codes

12001CPT Code

Simple repair of superficial wounds

Clinical Scenario

Used for the repair of the bite wound if surgical intervention is necessary.

Documentation Requirements

Document the size, location, and depth of the wound.

Specialty Considerations

Emergency medicine providers should ensure that the repair is documented accurately.

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 and management of trauma cases.

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 and management of trauma cases.

Reimbursement & Billing Impact

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

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 bite?

An open bite involves a break in the skin and exposure of underlying tissues, while a closed bite does not break the skin.