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ICD-10 Guide
ICD-10 CodesS11.25

S11.25

Billable

Open bite of pharynx and cervical esophagus

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 S11.25 is a billable code used to indicate a diagnosis of open bite of pharynx and cervical esophagus.

Key Diagnostic Point:

An open bite of the pharynx and cervical esophagus refers to a traumatic injury characterized by a laceration or puncture wound in the pharyngeal or cervical esophageal region. This type of injury can occur due to various mechanisms, including accidental trauma, bites from animals or humans, or penetrating injuries from sharp objects. Clinically, patients may present with symptoms such as difficulty swallowing (dysphagia), pain in the throat, and potential airway compromise. The injury can lead to significant complications, including infection, perforation, and mediastinitis if not promptly diagnosed and managed. Diagnostic approaches typically involve a thorough clinical examination, imaging studies such as CT scans, and endoscopic evaluation to assess the extent of the injury. Management may require surgical intervention, especially in cases of significant laceration or associated complications. Prompt recognition and treatment are crucial to prevent serious outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of injury
  • Need for detailed documentation of mechanism of injury
  • Potential for associated injuries in the cervical region
  • Differentiation from similar codes related to other types of injuries

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to specify the extent of the injury
  • Misclassification of the injury type (open vs. closed)
  • Lack of supporting clinical findings in the medical record

Specialty Focus

Medical Specialties

Emergency Medicine

Documentation Requirements

Documentation must include a detailed account of the injury mechanism, patient symptoms, and initial management steps.

Common Clinical Scenarios

Trauma cases involving bites or penetrating injuries to the neck.

Billing Considerations

Consideration of airway management and potential for rapid deterioration.

Surgery

Documentation Requirements

Operative reports must detail the surgical approach, findings, and any repairs performed.

Common Clinical Scenarios

Surgical intervention for lacerations requiring repair or drainage of abscesses.

Billing Considerations

Documentation should reflect the complexity of the surgical procedure and any complications encountered.

Coding Guidelines

Inclusion Criteria

Use S11.25 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the injury's mechanism, location, and any associated injuries
  • Use additional codes as necessary to capture complications or related conditions

Exclusion Criteria

Do NOT use S11.25 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

43191CPT Code

Esophagoscopy, rigid or flexible

Clinical Scenario

Used for diagnostic evaluation of esophageal injuries.

Documentation Requirements

Document indications for the procedure and findings.

Specialty Considerations

Important for both emergency and surgical specialties.

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 laceration or puncture that penetrates the tissue, while a closed bite does not break the skin but may cause bruising or swelling.