Lac w/o fb of abd wall, r upper q w penet perit cav, init

This code signifies a cut or tear in the right upper quadrant of the abdominal wall that extends through all layers, breaching the peritoneal cavity. It specifically indicates that no foreign object is embedded within the wound. This injury is considered an acute, initial presentation.

Use this code for patients presenting with a fresh, open wound to the right upper abdomen that has been clinically determined to penetrate the abdominal cavity. This would typically be seen in trauma cases where the integrity of the peritoneum has been compromised.

• Ensure documentation clearly states "right upper quadrant" and "penetration into peritoneal cavity."
• Verify the absence of a foreign body; if present, a different code would be required.
• The "A" in the seventh character indicates an initial encounter for this injury.