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v1.0.0
ICD-10 Guide
ICD-10 CodesS31.112

S31.112

Billable

Laceration without foreign body of abdominal wall, epigastric region without penetration into peritoneal cavity

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/23/2025

Code Description

ICD-10 S31.112 is a billable code used to indicate a diagnosis of laceration without foreign body of abdominal wall, epigastric region without penetration into peritoneal cavity.

Key Diagnostic Point:

S31.112 refers to a laceration of the abdominal wall specifically located in the epigastric region, which is the upper central part of the abdomen. This type of injury is characterized by a break in the skin and underlying tissues without the presence of a foreign body and does not penetrate the peritoneal cavity. Such lacerations can occur due to various traumatic events, including blunt or penetrating trauma, falls, or accidents. Clinically, these injuries may present with pain, swelling, and possible bleeding at the site of the laceration. It is crucial to assess the depth and extent of the injury to rule out damage to underlying structures such as muscles, nerves, or blood vessels. Emergency surgical intervention may be required if there is significant tissue loss or if the laceration is extensive. Proper documentation of the injury's characteristics, including size, depth, and any associated injuries, is essential for accurate coding and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for precise anatomical localization
  • Differentiation from similar codes (e.g., penetrating injuries)
  • Assessment of associated injuries in the abdominal region
  • Documentation of absence of foreign bodies

Audit Risk Factors

  • Inadequate documentation of injury specifics
  • Failure to specify the absence of foreign bodies
  • Misclassification with more severe abdominal injuries
  • Lack of follow-up documentation on treatment outcomes

Specialty Focus

Medical Specialties

Emergency Medicine

Documentation Requirements

Detailed description of the mechanism of injury, assessment of the laceration, and any interventions performed.

Common Clinical Scenarios

Patients presenting with abdominal trauma from accidents, falls, or assaults.

Billing Considerations

Ensure that all relevant details about the injury and treatment are documented to support the coding.

General Surgery

Documentation Requirements

Operative reports detailing the extent of the laceration, any repairs performed, and post-operative care.

Common Clinical Scenarios

Surgical intervention for extensive lacerations requiring suturing or other repair techniques.

Billing Considerations

Documentation must clearly indicate the nature of the laceration and any associated injuries to justify surgical procedures.

Coding Guidelines

Inclusion Criteria

Use S31.112 When
  • Follow official ICD
  • 10 coding guidelines, ensuring that the laceration is documented as not penetrating the peritoneal cavity and that there are no foreign bodies present
  • Include details about the mechanism of injury and any associated injuries

Exclusion Criteria

Do NOT use S31.112 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

12001CPT Code

Simple repair of laceration, face, ears, eyelids, scalp; 2.5 cm or less

Clinical Scenario

Used for simple repair of lacerations in the epigastric region.

Documentation Requirements

Document the size and depth of the laceration, along with the repair technique used.

Specialty Considerations

Ensure that the procedure aligns with the diagnosis for accurate billing.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of lacerations, improving the accuracy of data collection and reimbursement processes. S31.112 provides a clear distinction for lacerations without foreign bodies, enhancing clinical documentation and coding practices.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of lacerations, improving the accuracy of data collection and reimbursement processes. S31.112 provides a clear distinction for lacerations without foreign bodies, enhancing clinical documentation and coding practices.

Reimbursement & Billing Impact

reimbursement processes. S31.112 provides a clear distinction for lacerations without foreign bodies, enhancing clinical documentation and coding practices.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the significance of specifying 'without foreign body'?

Specifying 'without foreign body' is crucial as it differentiates the type of injury and impacts treatment decisions and coding accuracy.