Laceration with foreign body of hand
ICD-10 S61.42 is a billable code used to indicate a diagnosis of laceration with foreign body of hand.
S61.42 refers to a laceration of the hand that is complicated by the presence of a foreign body. This condition typically arises from traumatic incidents such as accidents involving sharp objects, machinery, or falls. The laceration may penetrate the skin and underlying tissues, potentially affecting muscles, tendons, nerves, and blood vessels. The presence of a foreign body, such as glass, metal, or wood, can complicate the injury, leading to increased risk of infection, delayed healing, and functional impairment. Proper assessment and management are crucial, as the foreign body must be identified and removed to prevent further complications. Surgical intervention may be necessary, especially if the laceration is deep or if there is significant damage to the surrounding structures. The clinical approach includes thorough cleaning of the wound, imaging studies to locate the foreign body, and possibly repair of any damaged tendons or nerves. Accurate coding is essential for appropriate treatment reimbursement and to reflect the complexity of the injury.
Detailed operative notes describing the laceration, foreign body removal, and any repairs performed.
Patients presenting with deep lacerations requiring surgical intervention and foreign body extraction.
Ensure documentation reflects the complexity of the injury and any associated repairs to tendons or nerves.
Comprehensive assessment notes including mechanism of injury, foreign body identification, and initial treatment provided.
Patients with acute hand injuries from accidents or falls, often requiring immediate evaluation and management.
Accurate documentation of the injury's mechanism and any imaging studies performed to locate foreign bodies.
Used for lacerations requiring simple closure without foreign body removal.
Document the size and location of the laceration.
Orthopedic surgeons may need to document additional details if tendon repair is involved.
Used when a foreign body is removed from a laceration.
Detailed operative report describing the procedure.
Emergency physicians must document the mechanism of injury and foreign body characteristics.
Documenting the foreign body is crucial for accurate coding, as it affects the complexity of the injury and the treatment required. It also impacts reimbursement and the overall management of the patient's care.
