Laceration without foreign body of abdominal wall, epigastric region with penetration into peritoneal cavity
ICD-10 S31.612 is a billable code used to indicate a diagnosis of laceration without foreign body of abdominal wall, epigastric region with penetration into peritoneal cavity.
S31.612 refers to a specific type of abdominal wall injury characterized by a laceration in the epigastric region that penetrates the peritoneal cavity without the presence of a foreign body. This condition often arises from blunt or penetrating trauma, such as stab wounds or accidents involving sharp objects. The epigastric region is located between the costal margins and above the umbilicus, making it a critical area for potential organ injury, including the stomach, liver, and pancreas. The penetration into the peritoneal cavity can lead to serious complications, such as peritonitis, hemorrhage, and organ damage. Immediate assessment and intervention are crucial to manage the injury effectively, often requiring surgical exploration to repair the laceration and address any associated injuries. Proper coding of this condition is essential for accurate medical billing and to ensure appropriate treatment protocols are followed.
Detailed account of the injury mechanism, vital signs, and initial treatment provided.
Patients presenting with stab wounds or blunt trauma to the abdomen.
Timely documentation is critical due to the urgency of treatment and potential for rapid deterioration.
Operative reports detailing the surgical approach, findings, and repairs made during the procedure.
Surgical intervention for abdominal lacerations with peritoneal penetration.
Accurate coding of any additional procedures performed during surgery is essential.
Used when surgical exploration is necessary due to penetrating abdominal trauma.
Operative report detailing findings and interventions.
General surgery documentation must include specifics of the laceration and any repairs performed.
Accurate coding of S31.612 is crucial for ensuring appropriate reimbursement, tracking patient outcomes, and facilitating effective treatment planning. It also helps in identifying trends in trauma cases for public health monitoring.
