S91.204S — Unspecified open wound of right lesser toe(s) with damage to nail, sequela
S91.204S is a billable, specific ICD-10-CM code for unspecified open wound of right lesser toe(s) with damage to nail, sequela. It is valid for submission on a claim.
7th character "S" — sequela
The appropriate 7th character is to be added to each code from category S91
- A
- initial encounter
- D
- subsequent encounter
- S
- sequela
Excludes1 inherited from the categories above S91.204S
These are not written on S91.204S, but they bind it: a note on a category applies to every code beneath it. Billing S91.204S with anything listed here is a denial.
Risk adjustment
S91.204S does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
S91.204S is named in 6 Medicare coverage policies — 6 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A53057Billing and Coding: Home Health Occupational Therapy
- A53058Billing and Coding: Home Health Physical Therapy
- A53064Billing and Coding: Outpatient Occupational Therapy
- A53065Billing and Coding: Outpatient Physical Therapy
Code history
S91.204S has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
Related codes at this level
Codes that share S91.204. If S91.204S is not quite right, the correct code is usually one of these.
Questions about S91.204S
- Is S91.204S a billable ICD-10-CM code?
- Yes. S91.204S is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does S91.204S sit in the tabular list?
- Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Injuries to the ankle and foot (S90-S99).
- What cannot be coded together with S91.204S?
- S91.204S carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above S91.204S (S91) and apply to it just the same.