Puncture wound with foreign body of left front wall of thorax with penetration into thoracic cavity
ICD-10 S21.342 is a billable code used to indicate a diagnosis of puncture wound with foreign body of left front wall of thorax with penetration into thoracic cavity.
A puncture wound with a foreign body in the left front wall of the thorax that penetrates into the thoracic cavity is a serious injury that can lead to various complications. This type of injury often results from penetrating trauma, such as gunshot wounds, stab wounds, or impalement injuries. The presence of a foreign body can complicate the clinical picture, as it may cause additional damage to the thoracic structures, including the lungs, heart, and major blood vessels. Patients may present with symptoms such as chest pain, difficulty breathing, and signs of shock. The injury can lead to pneumothorax (air in the pleural space), hemothorax (blood in the pleural space), rib fractures, and potential cardiac injuries. Immediate medical intervention is critical, often requiring thoracotomy or other surgical procedures to remove the foreign body and repair any damaged structures. The management of such injuries necessitates a multidisciplinary approach, including trauma surgery, critical care, and possibly cardiology, depending on the extent of the injury.
Detailed operative reports, imaging studies, and notes on the mechanism of injury.
Management of stab wounds, gunshot wounds, and other penetrating injuries.
Ensure all surgical interventions and complications are documented to support coding.
Initial assessment notes, imaging results, and treatment plans.
Acute management of trauma patients presenting with chest injuries.
Accurate documentation of vital signs and immediate interventions is crucial.
Used for drainage of pleural effusion or hemothorax.
Document indication for procedure and findings.
Ensure compliance with local guidelines for procedural coding.
Performed for exploration and repair of thoracic injuries.
Detailed operative report required.
Must document all findings and interventions.
Documentation must include details about the mechanism of injury, the presence and type of foreign body, any associated injuries, and the treatment provided, including surgical interventions.
