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ICD-10 Guide
ICD-10 CodesS81.051

S81.051

Billable

Open bite, right knee

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/26/2025

Code Description

ICD-10 S81.051 is a billable code used to indicate a diagnosis of open bite, right knee.

Key Diagnostic Point:

An open bite of the right knee refers to a specific type of injury characterized by a disruption of the skin and underlying tissues, resulting in an open wound at the knee joint. This injury can occur due to various mechanisms, including trauma from falls, sports injuries, or accidents. The open bite may expose underlying structures such as ligaments, tendons, and even bone, leading to potential complications such as infection or delayed healing. Clinically, patients may present with pain, swelling, and limited range of motion in the affected knee. Diagnosis typically involves a thorough physical examination and imaging studies, such as X-rays or MRI, to assess for associated injuries like fractures of the tibia or fibula, ligament tears, or other soft tissue damage. Treatment often requires surgical intervention to clean the wound, repair any damaged structures, and stabilize the knee joint. Rehabilitation is crucial for restoring function and preventing long-term complications. Accurate coding of this condition is essential for appropriate management and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between open and closed injuries
  • Identifying associated injuries (e.g., fractures, ligament tears)
  • Documenting the extent of the injury and treatment provided
  • Understanding the implications of open wounds in coding

Audit Risk Factors

  • Inadequate documentation of the injury mechanism
  • Failure to specify the extent of the open wound
  • Omission of associated injuries in the coding process
  • Incorrect linkage of procedures to the diagnosis

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and post-operative notes are essential for accurate coding.

Common Clinical Scenarios

Fractures associated with open bites, ligament repairs, and reconstructive surgeries.

Billing Considerations

Ensure all associated injuries are documented to support the complexity of the case.

Emergency Medicine

Documentation Requirements

Thorough initial assessment notes, including mechanism of injury and immediate treatment provided.

Common Clinical Scenarios

Initial evaluation of trauma patients with open knee injuries.

Billing Considerations

Accurate documentation of the injury type and any immediate interventions is critical.

Coding Guidelines

Inclusion Criteria

Use S81.051 When
  • According to ICD
  • 10 coding guidelines, S81
  • 051 should be used when there is a clear documentation of an open bite at the right knee
  • Coders must ensure that the injury is not classified under other codes for closed injuries or different anatomical locations

Exclusion Criteria

Do NOT use S81.051 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27506CPT Code

Repair of knee ligament

Clinical Scenario

Used when a ligament tear is identified during the treatment of an open bite.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must document the extent of the injury and any repairs performed.

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 ability to track and manage these injuries 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 ability to track and manage these injuries effectively.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of injuries, including open bites, which enhances the ability to track and manage these injuries 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 closed bite?

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