S01.109A — Unspecified open wound of unspecified eyelid and periocular area, initial encounter
Is S01.109A billable?
Yes, but S01.109A will trip a Medicare edit. S01.109A is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists S01.109A under Medicare Code Editor edit 20, “Unspecified code” — meaning a code specifying laterality (right, left or bilateral) exists in the same family. On an inpatient claim this triggers the edit, because CMS holds that there are very limited circumstances in which laterality cannot be documented.
More specific alternatives
- S01.111ALaceration without foreign body of right eyelid and periocular area, initial encounter
- S01.121ALaceration with foreign body of right eyelid and periocular area, initial encounter
- S01.131APuncture wound without foreign body of right eyelid and periocular area, initial encounter
- S01.141APuncture wound with foreign body of right eyelid and periocular area, initial encounter
- S01.151AOpen bite of right eyelid and periocular area, initial encounter
S01.109A at a glance
| Code | S01.109A |
|---|---|
| Description | Unspecified open wound of unspecified eyelid and periocular area, initial encounter |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "A" | initial encounter |
What does the 7th character "A" mean in S01.109A?
In S01.109A, the 7th character A means initial encounter. The 7th character is required for S01.109A to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
What Medicare edits apply to S01.109A?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name S01.109A directly.
A code specifying laterality (right, left or bilateral) exists in the same family. CMS holds that there are very limited circumstances in which laterality cannot be documented.
Which MS-DRGs does S01.109A group to?
S01.109A sits in MDC 02 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 124Other Disorders of the Eye with MCC or Thrombolytic Agentmedical
- 125Other Disorders of the Eye without MCCmedical
As a secondary diagnosis, S01.109A is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is S01.109A listed in the Alphabetic Index?
The Alphabetic Index lists these routes under S01.10, the nearest indexed parent of S01.109A. Use them to find the family, then select the specific code.
- Wound, open › eyelid
Excludes1 — never code together — inherited from S01
The conditions below can never be reported together with S01.109A on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- open skull fracture (S02.- with 7th character B)
Use additional code — inherited from Chapter 19
Report an additional code alongside S01.109A to fully describe the condition. S01.109A is sequenced first.
- code to identify any retained foreign body, if applicable (Z18.-)
Excludes2 — not included here — inherited from Chapter 19
The conditions below are not part of S01.109A, but a patient may have both at the same time. When documentation supports it, S01.109A and the excluded code may both be reported.
Excludes2 — not included here — inherited from S00-S09
The conditions below are not part of S01.109A, but a patient may have both at the same time. When documentation supports it, S01.109A and the excluded code may both be reported.
- burns and corrosions (T20-T32)
- effects of foreign body in ear (T16)
- effects of foreign body in larynx (T17.3)
- effects of foreign body in mouth NOS (T18.0)
- effects of foreign body in nose (T17.0-T17.1)
- effects of foreign body in pharynx (T17.2)
- effects of foreign body on external eye (T15.-)
- frostbite (T33-T34)
- insect bite or sting, venomous (T63.4)
Excludes2 — not included here — inherited from S01
The conditions below are not part of S01.109A, but a patient may have both at the same time. When documentation supports it, S01.109A and the excluded code may both be reported.
Code also — inherited from S00-S09
Two codes may be needed to describe the condition fully. Whether S01.109A is sequenced first depends on the reason for the encounter.
- for any associated infection
Code also — inherited from S01
Two codes may be needed to describe the condition fully. Whether S01.109A is sequenced first depends on the reason for the encounter.
How long has S01.109A existed?
S01.109A has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.