# Gunshot Wound - ? Qualify as Puncture Wound with foreign body



## Alli_77 (Jan 18, 2016)

Hi Everyone, 

If anyone has time, could you look at this and respond?

Scenario:
A patient had a gunshot wound that entered the left buttock and exited his left inner thigh.  The patient was fine.. no other problems.  No severed arteries, etc.


Which code would be most appropriate?

1.  S31.829A  Unspecified open wound of left buttock

2.  S31.824A  Puncture wound with foreign body of left buttock.

Also, "with foreign body", does this mean the foreign body was retained?
Since the bullet exited, should that be "without" foreign body (if puncture wound applies) ?

Does a gunshot wound qualify as a puncture wound, or must the MD state "puncture wound".  Are there any guidelines that state this?

If S31.824A is incorrect, what examples are there of a "puncture wound with a foreign body"?   (A nail gun comes to mind.. ouch!)

For the Record (4-09-2012) defines "puncture" as:  "a piercing wound that causes a small hole in the tissues.  Although the external wound is minor, there may be a more serious internal injury."     

After reading this puncture definition, and I think about how bullets work, they are designed to pierce a hole, but then explode once inside the body, therefore, I was thinking "puncture" would apply.   However, I need more a specific reference as to if this is correct or incorrect.


Reference:
ICD-10-CM INDEX:

1 Gunshot wound:   See wound, open
2. Wound, open, buttock (S31.809)   
                 Note: S31.809: "Unspecified open wound of unspecified buttock"
         puncture - see Puncture, buttock
3.      left  S31.829


1. Puncture, buttock
      left  S31.823
         with foreign body S31.824

Thanks in advance for your input.

-Allison


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## chelle511 (Jan 28, 2016)

*Researching..*

Hi.. I just ran across this scenario except bullet retained.. I am researching to see if any guidance... I am thinking that with this we will need to query the physician to clarify the type of open wound.




Alli_77 said:


> Hi Everyone,
> 
> If anyone has time, could you look at this and respond?
> 
> ...


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## tag60 (Jan 30, 2016)

I am seeing in that same article you referenced (For The Record, 4/9/12), mention of gunshot wound under the definition of avulsion:

Avulsion: a forcible tearing or partial tearing away of tissues typically caused by gunshot wounds, explosions, and animal bites.

So I don't think you can code it as a puncture wound. I would follow the Index and go with S31.829A.

I had same question about foreign body as you, and I was told it means it is retained/still present.


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