Puncture wound with foreign body of unspecified breast
ICD-10 S21.049 is a billable code used to indicate a diagnosis of puncture wound with foreign body of unspecified breast.
A puncture wound with a foreign body in the breast is a specific type of injury that occurs when an object penetrates the breast tissue, potentially causing damage to underlying structures. This injury can result from various incidents, including accidents, assaults, or surgical procedures. The presence of a foreign body can complicate the healing process and may lead to infections, abscess formation, or other complications. Clinically, patients may present with localized pain, swelling, and tenderness in the affected area. Imaging studies, such as ultrasound or mammography, may be necessary to assess the extent of the injury and the presence of foreign material. Treatment typically involves the removal of the foreign body, wound care, and monitoring for signs of infection. In some cases, surgical intervention may be required, especially if there is significant tissue damage or if the foreign body is deeply embedded. Accurate coding of this condition is crucial for appropriate management and reimbursement.
Detailed account of the injury mechanism, physical examination findings, and any imaging results.
Patients presenting with stab wounds, accidental punctures, or post-surgical complications.
Ensure that all associated injuries are documented, as they may affect treatment and coding.
Operative reports detailing the removal of foreign bodies and any reconstructive procedures performed.
Surgical intervention for foreign body removal, management of abscesses, or repair of damaged tissue.
Accurate coding of surgical procedures performed in conjunction with the injury is essential.
Used when an abscess forms due to a puncture wound with a foreign body.
Operative report detailing the procedure and findings.
Ensure that the reason for the procedure is clearly linked to the diagnosis.
Document the mechanism of injury, the presence and type of foreign body, any associated injuries, and the treatment provided.
