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S01.551 vs S02.5

S01.551 (Open bite of lip) compared with S02.5 (Fracture of tooth (traumatic)), from the official CMS tabular data.

Summary

These codes should not be reported together because S01.551’s tabular entry lists S02.5 under Excludes1.

Official rule
What is different?

The conditions named.S01.551 is “Open bite of lip”; S02.5 is “Fracture of tooth (traumatic)”.

Registry fact

Can these codes be reported together?

No.S01.551’s entry carries an Excludes1 note covering S02.5: “open skull fracture (S02.- with 7th character B)”. Both may be reported only when the documentation shows the two conditions are unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

Yes.S01.551’s tabular entry: “open skull fracture (S02.- with 7th character B)”. The note covers S02.5.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes2 relationship?

Yes.S01.551’s tabular entry: “tooth fracture (S02.5)”. The note covers S02.5.

Official ruleGuide: Excludes1 vs Excludes2

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Is one a parent or header code?

Both are headers.Both are non-billable headers, and neither contains the other.

Registry fact

Are there sequencing instructions?

None.Neither entry carries a Code First or Use Additional Code note that names the other.

Official rule

Are there other coding relationships?

None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.

MedCoder-derived

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Excludes1 — generally not reported together

Excludes1 conflict

S01.551
Open bite of lip
↔
S02.5
Fracture of tooth (traumatic)

What we found

No — do not report together.S01.551 carries an Excludes1 note covering S02.5: “open skull fracture (S02.- with 7th character B)”

Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

What to review

Report one of the two. Both may be reported only when the documentation shows the two conditions are unrelated to each other.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes1 note means the two conditions are not ordinarily reported together for the same encounter, because the classification treats them as mutually exclusive forms of the same condition. The documented exception is when the two conditions are unrelated to each other.

Source / rule

CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a

Informational

Excludes2 relationship

S01.551
Open bite of lip
↔
S02.5
Fracture of tooth (traumatic)

What we found

Yes, when both are documented.S01.551 carries an Excludes2 note covering S02.5: “tooth fracture (S02.5)”

Excludes2 marks distinct conditions — both may be reported when both are documented.

What to review

Report both only when the documentation supports both conditions; otherwise report the one documented.

Guide: Excludes1 vs Excludes2Check these on a claim

Why it matters

An Excludes2 note means the excluded condition is not part of the code above it, but a patient can have both. Report both when both are documented.

Source / rule

CMS ICD-10-CM tabular instructional notes

Official guidance behind these answers

  • Section I.A.12.a — Excludes1 · applies to: Excludes1

    A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. An exception to the Excludes1 definition is the circumstance when the two conditions are unrelated to each other. If it is not clear whether the two conditions involving an Excludes1 note are related or not, query the provider. For example, code F45.8, Other somatoform disorders, has an Excludes1 note for "sleep related teeth grinding (G47.63)," because "teeth grinding" is an inclusion term under F45.8. Only one of these two codes should be assigned for teeth grinding. However psychogenic dysmenorrhea is also an inclusion term under F45.8, and a patient could have both this condition and sleep related teeth grinding. In this case, the two conditions are clearly unrelated to each other, and so it would be appropriate to report F45.8 and G47.63 together.

    ICD-10-CM Official Guidelines FY2026

  • Section I.A.12.b — Excludes2 · applies to: Excludes2

    A type 2 Excludes note represents “Not included here.” An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

    ICD-10-CM Official Guidelines FY2026

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

S01.551Open bite of lipS02.5Fracture of tooth (traumatic)
Billing statusNon-billable header

Report instead: S01.551A, S01.551D, S01.551S

Non-billable header

Report instead: S02.5XXA, S02.5XXB, S02.5XXD, S02.5XXG, S02.5XXK

ClassificationS00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88)S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88)
DefinitionOpen bite of lip is a non-billable ICD-10-CM category code (S01.551).Fracture of tooth (traumatic) is a non-billable ICD-10-CM category code (S02.5).
7th characterThe appropriate 7th character is to be added to each code from category S01The appropriate 7th character is to be added to each code from category S02
Includes
injuries of ear
injuries of eye
injuries of face [any part]
injuries of gum
injuries of ear
injuries of eye
injuries of face [any part]
injuries of gum
Excludes1
superficial bite of lip (S00.571)
open skull fracture (S02.- with 7th character B)
cracked tooth (nontraumatic) (K03.81)
Excludes2
tooth dislocation (S03.2)
tooth fracture (S02.5)
injury of eye and orbit (S05.-)
traumatic amputation of part of head (S08.-)
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)
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)
Code also
any associated:
injury of cranial nerve (S04.-)
injury of muscle and tendon of head (S09.1-)
intracranial injury (S06.-)
wound infection
for any associated infection
any associated intracranial injury (S06.-)
for any associated infection

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on.

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Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources