Version 2024

2024 ICD-10-CM Diagnosis Code S05.42XA

Penetrating wound of orbit with or without foreign body, left eye, initial encounter

ICD-10-CM:: S05.42XA
Short Description:: Penetrating wound of orbit w or w/o fb, left eye, init
Is Billable?: Yes - Valid for Submission
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Code Classification

Injury, poisoning and certain other consequences of external causes
(S00–T88)
- Injuries to the head
  (S00-S09)
  - Injury of eye and orbit
    (S05)

S05.42XA is a billable diagnosis code used to specify a medical diagnosis of penetrating wound of orbit with or without foreign body, left eye, initial encounter. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024.

S05.42XA is an initial encounter code, includes a 7th character and should be used while the patient is receiving active treatment for a condition like penetrating wound of orbit with or without foreign body left eye. According to ICD-10-CM Guidelines an "initial encounter" doesn't necessarily means "initial visit". The 7th character should be used when the patient is undergoing active treatment regardless if new or different providers saw the patient over the course of a treatment. The appropriate 7th character codes should also be used even if the patient delayed seeking treatment for a condition.

1. Approximate Synonyms
2. Coding Guidelines
3. Tabular List of Diseases and Injuries
4. Diagnostic Related Groups - MS-DRG Mapping
5. Convert to ICD-9 Code
6. Patient Education
7. Other Codes Used Similar Conditions
8. Code History

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

Blow out fracture of orbit
Fracture of medial wall of orbit
Open blow-out fracture of left orbital floor
Open fracture of left orbit
Open fracture of left orbit
Open fracture of left orbit
Open fracture of left orbit
Open fracture of left orbital floor
Open fracture of medial wall of left orbit
Open fracture of medial wall of orbit
Open fracture of orbital floor
Penetrating wound of left orbit
Penetrating wound of orbit

Coding Guidelines

The appropriate 7th character is to be added to each code from block Injury of eye and orbit (S05). Use the following options for the aplicable episode of care:

A - initial encounter
D - subsequent encounter
S - sequela

Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
124	OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT	02	1.3219
125	OTHER DISORDERS OF THE EYE WITHOUT MCC	02	0.7975

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Convert to ICD-9-CM Code

Source ICD-10-CM Code		Target ICD-9-CM Code
S05.42XA		870.3 - Penetr wnd orbit w/o FB
Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code.
S05.42XA		870.4 - Penetrat wnd orbit w FB
Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code.

Patient Education

Eye Injuries

The structure of your face helps protect your eyes from injury. Still, injuries can damage your eye, sometimes severely enough that you could lose your vision. Most eye injuries are preventable. If you play sports or work in certain jobs, you may need protection.

The most common type of injury happens when something irritates the outer surface of your eye. Certain jobs such as industrial jobs or hobbies such as carpentry make this type of injury more likely. It's also more likely if you wear contact lenses.

Chemicals or heat can burn your eyes. With chemicals, the pain may cause you to close your eyes. This traps the irritant next to the eye and may cause more damage. You should wash out your eye right away while you wait for medical help.

[Learn More in MedlinePlus]

Wounds and Injuries

An injury is damage to your body. It is a general term that refers to harm caused by accidents, falls, hits, weapons, and more. In the U.S., millions of people injure themselves every year. These injuries range from minor to life-threatening. Injuries can happen at work or play, indoors or outdoors, driving a car, or walking across the street.

Wounds are injuries that break the skin or other body tissues. They include cuts, scrapes, scratches, and punctured skin. They often happen because of an accident, but surgery, sutures, and stitches also cause wounds. Minor wounds usually aren't serious, but it is important to clean them. Serious and infected wounds may require first aid followed by a visit to your doctor. You should also seek attention if the wound is deep, you cannot close it yourself, you cannot stop the bleeding or get the dirt out, or it does not heal.

Other common types of injuries include:

Animal bites
Bruises
Burns
Dislocations
Electrical injuries
Fractures (broken bones)
Sprains and strains