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ICD-10 Guide
ICD-10 CodesS81.059

S81.059

Billable

Open bite, unspecified knee

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

Code Description

ICD-10 S81.059 is a billable code used to indicate a diagnosis of open bite, unspecified knee.

Key Diagnostic Point:

An open bite of the knee refers to a type of injury characterized by a gap or discontinuity in the knee joint, which may be caused by trauma or other underlying conditions. This injury can involve damage to the skin, soft tissues, and potentially the underlying structures such as ligaments, tendons, or bones. Open bites can result from various incidents, including falls, sports injuries, or accidents, leading to significant pain, swelling, and functional impairment. The knee joint is complex, comprising bones (femur, tibia, fibula), cartilage, ligaments (ACL, PCL, MCL, LCL), and tendons, all of which can be affected by an open bite. Diagnosis typically involves a thorough clinical examination and imaging studies, such as X-rays or MRI, to assess the extent of the injury. Treatment may range from conservative management, including rest and physical therapy, to surgical interventions for severe cases, such as ligament reconstruction or repair of fractures. Accurate coding is essential for appropriate treatment planning and reimbursement, as well as for tracking injury patterns and outcomes in clinical practice.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in documentation of injury severity and type
  • Potential for associated injuries (fractures, ligament tears)
  • Need for precise anatomical localization
  • Differentiation from similar codes (e.g., closed bites or other knee injuries)

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify laterality when applicable
  • Lack of imaging reports to support the diagnosis
  • Inconsistent coding of associated injuries

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging studies, and follow-up assessments are crucial for accurate coding.

Common Clinical Scenarios

Common scenarios include traumatic knee injuries from sports, falls, or vehicular accidents requiring surgical intervention.

Billing Considerations

Orthopedic surgeons must document the specific structures involved and the extent of the injury to ensure accurate coding.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments of functional limitations and rehabilitation plans are necessary.

Common Clinical Scenarios

Patients recovering from knee injuries requiring rehabilitation services.

Billing Considerations

Documentation should reflect the patient's progress and any complications that may arise during recovery.

Coding Guidelines

Inclusion Criteria

Use S81.059 When
  • According to ICD
  • 10 coding guidelines, codes for open bites must be used with specificity regarding the location and nature of the injury
  • Documentation should clearly indicate the mechanism of injury and any associated conditions

Exclusion Criteria

Do NOT use S81.059 When
  • Exclusion criteria include injuries that are not classified as open bites or those that involve other anatomical regions

Related ICD-10 Codes

Related CPT Codes

27405CPT Code

Arthroscopy, knee, surgical

Clinical Scenario

Used for surgical intervention in cases of open bite with associated ligament damage.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons must ensure that the procedure aligns with the diagnosis for accurate billing.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of knee injuries, including open bites, which enhances the ability to track and analyze injury patterns and treatment outcomes. This specificity aids in improving patient care and optimizing reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of knee injuries, including open bites, which enhances the ability to track and analyze injury patterns and treatment outcomes. This specificity aids in improving patient care and optimizing reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

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. Accurate coding depends on this distinction.