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ICD-10 Guide
ICD-10 CodesS31.651

S31.651

Billable

Open bite of abdominal wall, left upper quadrant with penetration into peritoneal cavity

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

Code Description

ICD-10 S31.651 is a billable code used to indicate a diagnosis of open bite of abdominal wall, left upper quadrant with penetration into peritoneal cavity.

Key Diagnostic Point:

An open bite of the abdominal wall, specifically in the left upper quadrant, indicates a traumatic injury where the skin and underlying tissues are disrupted, leading to a wound that penetrates into the peritoneal cavity. This type of injury is often associated with significant trauma, such as from animal bites, sharp objects, or severe blunt force. The peritoneal cavity houses vital organs, including the stomach, spleen, and parts of the colon, making such injuries potentially life-threatening due to the risk of internal bleeding, infection, and organ damage. Immediate medical evaluation is crucial, often requiring imaging studies to assess the extent of the injury and potential complications. Surgical intervention may be necessary to repair the abdominal wall and address any damage to internal organs, as well as to prevent peritonitis, a serious infection of the peritoneal cavity. The management of this condition involves a multidisciplinary approach, including trauma surgery, emergency medicine, and critical care, to ensure optimal patient outcomes.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Requires detailed documentation of the mechanism of injury.
  • Involves understanding of anatomical terminology and specific quadrant injuries.
  • Potential for multiple associated injuries requiring comprehensive coding.
  • Need for precise differentiation between open and closed injuries.

Audit Risk Factors

  • Inadequate documentation of the injury mechanism.
  • Failure to document associated injuries or complications.
  • Incorrect coding of the injury type (open vs. closed).
  • Lack of clarity on surgical interventions performed.

Specialty Focus

Medical Specialties

Trauma Surgery

Documentation Requirements

Detailed operative reports, imaging studies, and notes on the mechanism of injury.

Common Clinical Scenarios

Management of traumatic abdominal injuries, including open bites and lacerations.

Billing Considerations

Accurate documentation of the extent of injury and any surgical repairs performed.

Emergency Medicine

Documentation Requirements

Initial assessment notes, vital signs, and any immediate interventions taken.

Common Clinical Scenarios

Initial evaluation and stabilization of patients with abdominal trauma.

Billing Considerations

Clear documentation of the patient's condition upon arrival and any changes during treatment.

Coding Guidelines

Inclusion Criteria

Use S31.651 When
  • Follow official ICD
  • CM coding guidelines, ensuring accurate documentation of the injury type, location, and any associated complications
  • Include details on the mechanism of injury and any surgical procedures performed

Exclusion Criteria

Do NOT use S31.651 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

49000CPT Code

Exploratory laparotomy

Clinical Scenario

Performed to assess and repair injuries to the peritoneal cavity.

Documentation Requirements

Operative report detailing findings and interventions.

Specialty Considerations

Trauma surgeons must document the extent of injury and any repairs made.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of traumatic injuries, improving the accuracy of data collection and reimbursement processes. S31.651 provides a clear distinction for open bites with peritoneal involvement, which was less specific in ICD-9.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of traumatic injuries, improving the accuracy of data collection and reimbursement processes. S31.651 provides a clear distinction for open bites with peritoneal involvement, which was less specific in ICD-9.

Reimbursement & Billing Impact

reimbursement processes. S31.651 provides a clear distinction for open bites with peritoneal involvement, which was less specific in ICD-9.

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 is the significance of coding S31.651 accurately?

Accurate coding of S31.651 is crucial for proper reimbursement, tracking of trauma cases, and ensuring that patients receive appropriate care based on the severity of their injuries.