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ICD-10 Guide
ICD-10 CodesS31.541

S31.541

Billable

Puncture wound with foreign body of unspecified external genital organs, male

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

Code Description

ICD-10 S31.541 is a billable code used to indicate a diagnosis of puncture wound with foreign body of unspecified external genital organs, male.

Key Diagnostic Point:

A puncture wound with a foreign body in the external genital organs of males can result from various incidents, including accidents, assaults, or self-inflicted injuries. This type of injury may involve the introduction of foreign materials such as metal, glass, or other objects into the genital area, leading to potential complications such as infection, hemorrhage, or damage to underlying structures. The management of such injuries often requires a thorough assessment to determine the extent of tissue damage and the presence of foreign bodies. Emergency surgical intervention may be necessary to remove the foreign object, repair any lacerations, and prevent further complications. The complexity of treatment can vary based on the location and depth of the wound, as well as the patient's overall health status. Proper documentation is crucial to ensure accurate coding and reimbursement, as well as to facilitate appropriate follow-up care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential foreign bodies and their implications for treatment
  • Need for detailed documentation of the injury mechanism
  • Variability in clinical presentation and required interventions
  • Potential for associated injuries in the pelvic region

Audit Risk Factors

  • Inadequate documentation of the mechanism of injury
  • Failure to document the presence of foreign bodies
  • Lack of clarity regarding the extent of the injury
  • Improper coding of associated injuries

Specialty Focus

Medical Specialties

Urology

Documentation Requirements

Detailed notes on the nature of the injury, any foreign bodies present, and the treatment provided.

Common Clinical Scenarios

Management of puncture wounds from accidents or assaults, including foreign body removal.

Billing Considerations

Consideration of potential urinary tract injuries and the need for imaging studies.

Emergency Medicine

Documentation Requirements

Comprehensive assessment of the injury, including vital signs, mechanism of injury, and immediate interventions.

Common Clinical Scenarios

Initial evaluation and stabilization of patients with puncture wounds to the genital area.

Billing Considerations

Rapid assessment for associated injuries and potential need for surgical consultation.

Coding Guidelines

Inclusion Criteria

Use S31.541 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the injury's specifics, including the mechanism of injury and any foreign bodies

Exclusion Criteria

Do NOT use S31.541 When
  • Ensure compliance with inclusion and exclusion criteria for accurate coding

Related ICD-10 Codes

Related CPT Codes

12001CPT Code

Simple repair of superficial wounds

Clinical Scenario

Used for repair of the puncture wound after foreign body removal.

Documentation Requirements

Document the size of the wound and the method of repair.

Specialty Considerations

Urology may require additional documentation for any urinary tract involvement.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of injuries, including those involving foreign bodies, which enhances the accuracy of medical records and billing.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of injuries, including those involving foreign bodies, which enhances the accuracy of medical records and billing.

Reimbursement & Billing Impact

billing.

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 should be documented for a puncture wound with a foreign body?

Document the mechanism of injury, the type of foreign body, the extent of the wound, any associated injuries, and the treatment provided.