General Question for the Week of June 21, 2021

Question:

What is your opinion on how to use diagnosis Z18.10 – Retained foreign body fragments, metal – for a new gunshot wound (GSW)? I think of ‘retained’ as being old and embedded, but there are differing opinions in my department. If the patient has a new GSW to the tibia and fibula with fractures and for a chest and abdomen x-ray taken around the same time as the tibia & fibula, they state in the impression, “small metallic fragments project over the left middle to upper lung zone and left lateral abdominal wall, likely from a gunshot wound”, would you use Wound, unspecified to the abdomen and chest walls or retained foreign body fragments, metal? Or neither?

Answer:

Coding Clinic, 3rd Quarter, 2016 had a similar question with a patient having a gunshot wound with retained bullet fragments. In the question, there were no fractures. Coding Clinic noted that the appropriate puncture wound with the foreign body as the primary code, with Z18.89 – other specified retained foreign body fragments as an additional diagnosis. A puncture wound is more appropriate than laceration since the bullet punctured through the skin. A laceration implies cutting. However, I would use Z18.10 in your case instead of Z18.89 for the fragments in the chest and abdomen, since the radiologist specified metallic fragments “likely” from a gunshot wound. That “likely” makes it “unspecified” instead of “other specified” as in Z18.89.