Unspecified open wound of left hand
ICD-10 S61.402 is a billable code used to indicate a diagnosis of unspecified open wound of left hand.
An unspecified open wound of the left hand refers to a traumatic injury that results in a break in the skin and exposure of underlying tissues, without a specific description of the wound's characteristics. This type of injury can occur due to various mechanisms, including lacerations, punctures, or abrasions, and may involve damage to skin, subcutaneous tissue, and potentially deeper structures such as tendons, nerves, and blood vessels. The left hand is often subject to injuries from accidents, falls, or sharp objects, leading to complications such as infection, impaired function, or chronic pain. Treatment may involve wound cleaning, suturing, and possibly surgical intervention if deeper structures are involved. Accurate documentation is crucial to determine the extent of the injury and guide appropriate management, including potential referrals to specialists for tendon repair or nerve reconstruction if indicated. The unspecified nature of the code indicates that further details about the wound's characteristics or associated injuries are not provided, which can complicate treatment planning and coding.
Detailed descriptions of the injury, including mechanism of injury, structures involved, and treatment provided.
Fractures associated with open wounds, tendon repairs, and nerve injuries.
Ensure that all surgical interventions and follow-up care are documented to support coding.
Thorough assessment of the wound, including size, depth, and any foreign bodies present.
Acute trauma cases presenting with open wounds requiring immediate care.
Document all interventions performed in the emergency setting, including imaging and consultations.
Used for suturing an open wound on the left hand.
Document the size of the wound and the method of repair.
Orthopedic surgeons may need to document any associated tendon or nerve repairs.
Document the mechanism of injury, depth of the wound, any associated injuries, and the treatment provided to support the use of this code.
