Laceration without foreign body of unspecified part of thorax
ICD-10 S21.91 is a billable code used to indicate a diagnosis of laceration without foreign body of unspecified part of thorax.
S21.91 refers to a laceration of the thorax that does not involve a foreign body and is unspecified in terms of location. This type of injury can occur due to various mechanisms, including blunt trauma, penetrating trauma, or accidents. The thorax houses vital organs such as the heart and lungs, making lacerations in this area potentially serious. Complications may include rib fractures, pneumothorax (air in the pleural space), hemothorax (blood in the pleural space), and cardiac injuries. Accurate coding is essential for appropriate management and treatment planning. Patients may present with symptoms such as chest pain, difficulty breathing, or signs of shock. The management of thoracic lacerations may involve surgical intervention, especially if there is significant damage to underlying structures or if the injury is complicated by other thoracic conditions. Proper documentation of the mechanism of injury, associated symptoms, and any surgical procedures performed is crucial for accurate coding and billing.
Detailed account of the mechanism of injury, vital signs, and any immediate interventions performed.
Trauma cases from accidents, falls, or assaults leading to chest lacerations.
Ensure all associated injuries are documented, including rib fractures or pneumothorax.
Comprehensive surgical notes detailing the procedure, findings, and any complications.
Surgical repair of thoracic lacerations, management of hemothorax or pneumothorax.
Document the extent of the laceration and any reconstructive efforts made.
Used for initial evaluation of a patient with a thoracic laceration.
Document the patient's history, examination findings, and treatment plan.
Emergency medicine providers should ensure thorough documentation of the injury mechanism.
S21.91 specifies a laceration without foreign body, while S21.90 is an unspecified injury of the thorax that does not provide details about the type of injury.