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ICD-10 Guide
ICD-10 CodesS21.259

S21.259

Billable

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

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

Code Description

ICD-10 S21.259 is a billable code used to indicate a diagnosis of open bite of unspecified back wall of thorax without penetration into thoracic cavity.

Key Diagnostic Point:

An open bite of the thorax refers to a traumatic injury where the skin and underlying tissues are disrupted, resulting in a wound that does not penetrate the thoracic cavity. This type of injury can occur due to various mechanisms, including animal bites, human bites, or sharp objects. The back wall of the thorax encompasses the posterior aspect of the rib cage, which houses vital structures such as the lungs and heart. Although this specific injury does not involve penetration into the thoracic cavity, it can still lead to significant complications, including infection, hematoma formation, or damage to the underlying ribs and muscles. Clinicians must assess the injury carefully to rule out associated conditions such as rib fractures, pneumothorax, or hemothorax, which may require further intervention. Treatment typically involves wound care, potential surgical intervention for extensive injuries, and monitoring for complications. Accurate coding is essential for appropriate management and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between open and closed injuries
  • Assessing for associated rib fractures or internal injuries
  • Documentation of the mechanism of injury
  • Potential for complications requiring additional coding

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to document associated injuries or complications
  • Misclassification of the injury type (open vs. closed)
  • Inconsistent coding practices among different 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, trauma from falls, or sports injuries.

Billing Considerations

Ensure thorough documentation of any potential complications, such as rib fractures or pneumothorax.

Surgery

Documentation Requirements

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

Common Clinical Scenarios

Surgical repair of extensive thoracic wall injuries or management of complications.

Billing Considerations

Accurate coding of any surgical procedures performed in conjunction with the injury.

Coding Guidelines

Inclusion Criteria

Use S21.259 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used for open bites specifically affecting the back wall of the thorax without thoracic cavity penetration
  • Document any associated injuries or complications separately

Exclusion Criteria

Do NOT use S21.259 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

12001CPT Code

Simple repair of superficial wounds

Clinical Scenario

Used for the repair of the open bite wound.

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 the 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 helps in better tracking and management of trauma cases. This specificity aids in research and quality improvement initiatives.

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. This specificity aids in research and quality improvement initiatives.

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. This specificity aids in research and quality improvement initiatives.

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 injury?

An open bite involves a break in the skin and underlying tissues, while a closed injury does not penetrate the skin. Open bites can lead to more complications, such as infection.