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S21.15 Non-Billable FY2027 Status: Active

S21.15: Open bite of front wall of thorax w/o penet thoracic cavity

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

Effective Date: 2026-10-01
Dataset: ICD-10-CM FY2027
Source: Centers for Disease Control and Prevention (CDC)
Last Verified: 2026-10-01
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Quick Clinical & Billing Summary

What is ICD-10-CM code S21.15? S21.15 represents Open bite of front wall of thorax w/o penet thoracic cavity. Under official CDC guidelines, this code is non-billable and requires additional specificity.

Current release: FY2027 (Effective October 1, 2026). Sourced directly from CDC NCHS files.

Code Hierarchy & Classification

Chapter 19: Injury, poisoning and certain other consequences of external causes
⌊ Category S21: Open wound of thorax
⌊ S21.15: Open bite of front wall of thorax w/o penet thoracic cavity (Current Code)

Clinical Guidance & Documentation Standards

Clinical documentation should substantiate the medical necessity of this diagnosis, including laterality, anatomical site specificity, and clinical severity.

7th Character Episode of Care Builder

Chapter 19 Requirement

ICD-10-CM coding guidelines mandate assigning an appropriate 7th character for traumatic injuries, fractures, and external causes to denote the episode of care:

A Initial Encounter
Patient receiving active clinical treatment (surgical evaluation, emergency care, initial casting).
D Subsequent Encounter
Patient receiving routine care during healing phase (cast change, medication adjustment, follow-up).
S Sequela (Late Effect)
Complications or conditions arising as a direct late consequence of the healed injury.
Placeholder X Rule: If the diagnosis code has fewer than 6 characters, you must append placeholder 'X' characters to maintain the 7th character position. Use 7th Character Builder Tool →

Associated Procedures & Medicare RVU Reimbursement

Open RVU Calculator →

Typical outpatient and office evaluation procedures frequently billed alongside diagnosis S21.15:

CPT/HCPCS Description Work RVU Non-Facility Fee Facility Fee
99213 Office/outpatient visit, established patient, 20-29 minutes (Low MDM) 1.30 $91.69 $66.79
99214 Office/outpatient visit, established patient, 30-39 minutes (Moderate MDM) 1.92 $133.61 $100.21
96372 Therapeutic, prophylactic, or diagnostic injection (subcutaneous/intramuscular) 0.17 $18.34 $12.44
Based on official CMS 2026 Physician Fee Schedule conversion factor ($32.7476). Payments vary by locality GPCI.

CPT Modifier & Billing Rules

Modifier 25 Significant E/M

Append when a significant, separately identifiable evaluation and management service is provided on the same calendar day as a minor surgical procedure or injection.

Modifier 59 Distinct Service

Identifies procedures or services not normally reported together but distinct under the clinical circumstances. Use CMS X-modifiers (XE, XS, XP, XU) where required by Medicare.

Check NCCI Procedure to Procedure (PTP) unbundling rules in NCCI Checker →

Frequently Asked Questions about S21.15

Is S21.15 a billable ICD-10 code?

No, S21.15 is a non-billable category code that requires additional digits to specify clinical details.

What is the ICD-10 code for Open bite of front wall of thorax w/o penet thoracic cavity?

The primary ICD-10-CM code for Open bite of front wall of thorax w/o penet thoracic cavity is S21.15.

What is the effective date of the current S21.15 code?

The code is active for fiscal year FY2027, effective starting 2026-10-01.

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Official Provenance: Sourced from CDC / NCHS FY2027 ICD-10-CM files. Report a Data Error
Verified: 2026-10-01