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S27.0XXD

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🧬 ICD-10 CM S27.0XXD — Traumatic Pneumothorax, Subsequent Encounter

Billable Code Confirmed

ICD-10 CM S27.0XXD is a 7-character code: S27.0 is traumatic pneumothorax, the two X characters are placeholders that bring the code to 7 characters, and D is subsequent encounter. It is a valid, billable, POA-exempt code for FY2026.1,2

Non-Billable Parent Codes

S27.0 (Traumatic pneumothorax) is a non-billable category that needs the X placeholders and the 7th character.3,4 S27 (Injury of other and unspecified intrathoracic organs) is a non-billable category that needs the organ, injury type, and 7th character.

Clinical Context

The “traumatic” in this code is the key decision point. Pneumothorax with no documented injury mechanism, such as spontaneous pneumothorax, belongs in J93.- and is blocked by the Excludes1 note.3

Code Classification

This is an ICD-10-CM diagnosis code from the Injury chapter, and it is not a procedure code.

🔍 Code Description

ICD-10 CM S27.0XXD describes air in the pleural space caused by chest trauma, reported when the patient is being followed in the recovery phase. Traumatic pneumothorax occurs when the chest wall is pierced, as in a stab or gunshot wound, and it can also follow blunt trauma.6 The S27 category carries a “code also” note for any associated open wound of the thorax (S21.-), and rib fractures are coded separately, for example with S22.31XD.3

In rehab, the pneumothorax is usually one of several injuries from a trauma, so the code supports medical necessity for monitoring such as chest imaging, oxygen needs, and activity tolerance. The other 7th characters for this code are S27.0XXA (initial) and S27.0XXS (sequela), and related intrathoracic injuries include S27.1XXD and S27.2XXD.2

🌳 Code Tree / Hierarchy

S27 Injury of other and unspecified intrathoracic organs ❌ Non-billable
│
├── S27.0 Traumatic pneumothorax ❌ Non-billable
│ │
│ ├── S27.0XXA Traumatic pneumothorax, initial encounter ✅ Billable
│ ├── S27.0XXD Traumatic pneumothorax, subsequent encounter ◀ THIS CODE ✅ Billable
│ └── S27.0XXS Traumatic pneumothorax, sequela ✅ Billable
│
├── S27.1 Traumatic hemothorax ❌ Non-billable
│ │
│ └── S27.1XXD Traumatic hemothorax, subsequent encounter ✅ Billable
│
├── S27.2 Traumatic hemopneumothorax ❌ Non-billable
│ │
│ └── S27.2XXD Traumatic hemopneumothorax, subsequent encounter ✅ Billable
│
└── S27.9 Injury of unspecified intrathoracic organ ❌ Non-billable
  │
  └── S27.9XXD Injury of unspecified intrathoracic organ, subsequent encounter ✅ Billable

Pneumothorax vs Hemopneumothorax

If the record documents both air and blood in the pleural space after trauma, the combination code S27.2XXD applies, and not S27.0XXD plus S27.1XXD. Check imaging and chest tube output notes for blood.

Tip

The code has no laterality character, so document the side in the narrative for clinical clarity even though the code cannot capture it.

✅ Includes

  • The code applies to pneumothorax documented as due to chest trauma, whether blunt or penetrating.6
  • The S27 “code also” note applies to any associated open wound of the thorax (S21.-).3

❌ Excludes

Excludes 1

  • J93.- — Spontaneous pneumothorax. It cannot be reported with S27.0XXD because the two describe different causes.3,4

Danger

The most common error is reporting a J93 spontaneous pneumothorax code alongside S27.0XXD for the same pneumothorax. A second error is using S27.0XXD when the provider documents the pneumothorax as a complication of a procedure, which is a different code category.

Excludes 2

  • The S27 category excludes injury of the cervical esophagus and cervical trachea (S10-S19), which are coded to the neck injury block.3 Rib fractures, lung contusion, and open chest wounds are coded separately when documented.

📋 Clinical Overview

Air vs Blood in the Pleural Space

The S27 codes separate injuries by what is in the pleural space. Air alone is pneumothorax, blood alone is hemothorax, and both together is hemopneumothorax.3

FeatureS27.0XXDRelated S27.1XXDRelated S27.2XXD
Pleural contentsAir.Blood.Air and blood.
Typical imagingVisible pleural air line or absent lung markings.Pleural fluid or layering opacity.Air-fluid level in the pleural space.
Documentation keyProvider documents traumatic pneumothorax.Provider documents traumatic hemothorax.Provider documents hemopneumothorax.

Important

A CDI trigger is “chest trauma with air in chest” or “PTX” with no cause. Query whether the pneumothorax is traumatic, spontaneous, or procedure-related so the right code category is used.

Manifestations & Symptom Burden

  • Shortness of breath or reduced exercise tolerance may limit therapy participation.
  • Pleuritic chest pain can affect breathing exercises and mobility.
  • Residual air or a retained chest tube requires monitoring and imaging follow-up.
  • Rib fractures often coexist and affect pain and respiratory effort.

Tip

Report symptoms such as dyspnea only if they are not integral to the pneumothorax, and only when the provider documents them as separate problems.

💰 HCC Risk Adjustment

FieldValue
ICD-10-CM CodeS27.0XXD
HCC CategoryN/A — no mapping found
RAF ImpactNone expected on its own
Annual CaptureNot required for this code
Payer NoteVerify with the current CMS mapping file and your payer

Confirm in the CMS model software mapping before relying on this.

🏥 MS-DRG Assignment

FieldValue
MDC (acute-care reference)MDC 04 — Respiratory System (verify)
DRG with MCC205 — Other Respiratory System Diagnoses with MCC (verify)
DRG without MCC206 — Other Respiratory System Diagnoses without MCC (verify)

In inpatient rehab, payment comes from the IRF-PAI impairment group and case-mix group, and a traumatic pneumothorax is typically a secondary condition. The code is exempt from POA reporting on acute-care inpatient claims.2

  • Check your MAC for any articles on chest imaging or pulmonary services that list this diagnosis.

🔗 Related ICD-10-CM Codes

Same injury, other encounter types and thoracic injury types: S27.0XXA, S27.0XXS, S27.1XXD, S27.2XXD, S27.9XXD2,3

Commonly coexisting chest trauma: S22.31XD, S22.32XD1

🛠️ Commonly Associated CPT Codes

  • 99233: Subsequent hospital inpatient care, high level. It supports management of a medically complex rehab patient with respiratory issues.
  • 99232: Subsequent hospital inpatient care, moderate level. It covers routine rehab rounds with active management of the pneumothorax.
  • 71045: Chest X-ray, single view. It is commonly used to confirm resolution of the pneumothorax.
  • 71046: Chest X-ray, 2 views. It is used for a more complete follow-up study.
  • 32551: Tube thoracostomy, includes connection to drainage system. It applies if a chest tube is placed or replaced, and it carries a 0-day global.

🏷️ Modifier Reference

ModifierNameWhen to Apply
-26Professional ComponentUse when the physician interprets the chest X-ray, and the facility reports the technical component.
-TCTechnical ComponentUse for the technical component only, by the entity that owns the equipment.
-25Significant E/MUse when a significant, separately identifiable E/M is performed on the same day as a procedure such as tube thoracostomy.
-RTRight SideUse when a procedure such as tube placement is performed on the right side and the CPT code does not specify side.
-LTLeft SideUse when a procedure such as tube placement is performed on the left side and the CPT code does not specify side.
-59Distinct ServiceUse to show a separate site or session when NCCI would otherwise bundle the codes, and only when documentation supports it.

NCCI Bundling Considerations

Tube thoracostomy includes the connection to the drainage system, and imaging guidance may be bundled depending on the code pair. Check NCCI PTP edits before reporting imaging on the same day as a thoracostomy.

🔬 ICD-10-PCS Crosswalk

ICD-10 CM S27.0XXD is a diagnosis for ongoing care and has no direct PCS match. These are root-operation tables only, so select the full 7-character code from the current FY2026 PCS tables.

  • 0W9 (Drainage, Anatomical Regions, General): Table root for chest tube drainage of the pleural cavity.
  • 0BH (Insertion, Respiratory System): Table root for device insertion in the respiratory system, which can apply when a chest tube is placed.
  • 0BP (Removal, Respiratory System): Table root for later removal of an indwelling device.

💊 Coding Scenarios and Examples


Example 1

Clinical Scenario:
A trauma patient is in inpatient rehab with multiple rib fractures and a resolving traumatic pneumothorax. The physiatrist reviews a repeat chest X-ray and adjusts the activity plan on rounds.

FieldCodeRationale
CPT99232Subsequent hospital care with moderate-level decision making.
PDxS27.0XXDTraumatic pneumothorax being monitored in the rehab stay.
Dx 2S22.31XDRight rib fracture documented as part of the same trauma.

Tip

Sequence the injury that most drives the visit first, and add the other documented injuries as secondary diagnoses. CDI: document the imaging result and the effect on therapy.

Example 2

Clinical Scenario:
The physician interprets a 2-view chest X-ray to confirm the pneumothorax has resolved before clearing the patient for more active therapy.

FieldCodeRationale
CPT71046--26Professional interpretation of the 2-view chest X-ray.
PDxS27.0XXDFollow-up of the traumatic pneumothorax.

Tip

Link the imaging to S27.0XXD to support medical necessity. CDI: the report should state the clinical question and the comparison with prior studies.

Example 3

Clinical Scenario:
A rehab patient with traumatic pneumothorax has a recurrent small collapse. A chest tube is placed on the left side at the bedside, and the physician bills a visit the same day.

FieldCodeRationale
CPT32551--LTTube thoracostomy on the left side.
CPT 299233--25Significant, separately identifiable E/M on the same day as the procedure.
PDxS27.0XXDTraumatic pneumothorax being treated.

Tip

The E/M with -25 needs documentation that goes beyond the usual pre-procedure work. CDI: document the indication for the chest tube and the findings.

⚠️ Coding Pitfalls and Tips

  • Pitfall 1: Reporting a J93 spontaneous pneumothorax code with S27.0XXD; Tips: Respect the Excludes1 note and choose by documented cause.
  • Pitfall 2: Using S27.0XXD and S27.1XXD together when blood and air are both documented; Tips: Use S27.2XXD for hemopneumothorax.
  • Pitfall 3: Dropping the S21 open wound code when a penetrating injury is documented; Tips: Follow the “code also” note and code the open wound with its own 7th character.
  • Pitfall 4: Coding pneumothorax with no documented cause as traumatic; Tips: Query the provider when the cause is missing.
  • Pitfall 5: Missing the two X placeholders in the code; Tips: Enter S27.0XXD with both X characters so the code is 7 characters.
  • Pitfall 6: Coding a pneumothorax as traumatic when it is documented as a complication of a procedure; Tips: Read the documentation for cause, and use the procedural complication category when stated.

📚 Sources

1. ICD10Data.com. *2026 ICD-10-CM Diagnosis Code S27.0XXD.* https://www.icd10data.com/ICD10CM/Codes/S00-T88/S20-S29/S27-/S27.0XXD 2. ICD List. *ICD-10-CM Diagnosis Code S27.0XXD — Traumatic pneumothorax, subsequent encounter.* https://icdlist.com/icd-10/S27.0XXD 3. AAPC. *ICD-10 Code for Traumatic pneumothorax — S27.0.* https://www.aapc.com/codes/icd-10-codes/S27.0 4. Vero Scribe. *ICD-10-CM S27.0: Traumatic pneumothorax.* https://www.veroscribe.com/icd-10/codes/S27.0 5. Unbound Medicine. *S27.0XXD — Traumatic pneumothorax [subsequent encounter].* ICD-10-CM. https://www.unboundmedicine.com/icd/view/ICD-10-CM/938269/all/S27_0XXD___Traumatic_pneumothorax_ 6. National Library of Medicine (PMC). *Pneumothorax: from definition to diagnosis and treatment.* https://pmc.ncbi.nlm.nih.gov/articles/PMC4203989/

Sources listed above correspond to superscript citations throughout this note. Verify all Medicare payment figures against your current CMS PFS Lookup tool and applicable MAC LCD prior to claim submission. Please use the latest AAPC/AHIMA Coding Books to verify each code within this note.

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