S31.111A

🧬 ICD-10 CM S31.111A — Laceration Without Foreign Body Of Abdominal Wall, Left Upper Quadrant Without Penetration Into Peritoneal Cavity, Initial Encounter

Billable Code Confirmed

ICD-10-CM S31.111A is a valid, billable 7-character ICD-10-CM code for FY2026.¹ The 4th character (“1”) defines the abdominal wall without peritoneal penetration, the 5th character (“1”) specifies a laceration without a foreign body, the 6th character (“1”) identifies the left upper quadrant (LUQ), and the 7th character (“A”) designates the initial encounter. No additional characters are required.

Non-Billable Parent Codes — Never Submit These

• ❌ S31.1 — 4-character header — Lacks specific injury type, quadrant location, and encounter character.
• ❌ S31.11 — 5-character header — Lacks quadrant location and encounter character.
• ❌ S31.111 — 6-character header — Lacks the 7th character for the episode of care (encounter).

Always submit S31.111A (all 7 characters) when a patient is receiving active treatment for a clean LUQ abdominal wall cut that does not pierce the peritoneum.

Clinical Context: Penetration of the Peritoneum

ICD-10 CM S31.111A captures an open wound limited strictly to the superficial and muscular layers of the abdominal wall. If the laceration penetrates the peritoneal cavity (exposing or damaging internal organs like the spleen or stomach in the LUQ), you must instead use a code from the S31.6- subcategory, which indicates significantly higher clinical severity and risk of intra-abdominal sepsis.

Code Classification

ICD-10-CM Diagnosis Code — wRVU, assistant payable, and global period fields are not applicable; direct reader to the Commonly Associated CPT Codes and ICD-10-PCS Crosswalk sections for procedural equivalents.

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🔍 Code Description

ICD-10 CM S31.111A classifies Laceration without foreign body of abdominal wall, left upper quadrant without penetration into peritoneal cavity, initial encounter. This code denotes a traumatic cut or tear in the skin, subcutaneous fat, and potentially the musculature of the left upper quadrant (LUQ) of the abdomen, without any retained debris (foreign body) inside the wound, and stopping short of piercing the protective peritoneal lining.

The 7th character “A” (Initial encounter) is assigned during the period of active treatment. This includes evaluation in the emergency department, surgical exploration to confirm depth, wound irrigation, primary closure (suturing/stapling), or the initial prescription of prophylactic antibiotics.

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🌳 Code Tree / Hierarchy

S30-S39 Injuries to the abdomen, lower back, lumbar spine, pelvis and external genitals ❌ Non-billable
│
├── S31 Open wound of abdomen, lower back, pelvis and external genitals ❌ Non-billable
│ │
│ ├── S31.0 Open wound of lower back and pelvis ❌ Non-billable
│ ├── S31.1 Open wound of abdominal wall without penetration into peritoneal cavity ❌ Non-billable
│ │ │
│ │ ├── S31.10 Unspecified open wound of abdominal wall... ❌ Non-billable
│ │ ├── S31.11 Laceration without foreign body of abdominal wall... ❌ Non-billable
│ │ │ │
│ │ │ ├── S31.110 Laceration without foreign body of abdominal wall, right upper quadrant... ❌ Non-billable
│ │ │ ├── S31.111 Laceration without foreign body of abdominal wall, left upper quadrant... ❌ Non-billable
│ │ │ │ │
│ │ │ │ ├── S31.111A Laceration without fb of abd wall, LUQ w/o penet perit cav, init ◀ THIS CODE ✅ Billable
│ │ │ │ ├──S31.111D Laceration without fb of abd wall, LUQ w/o penet perit cav, subs ✅ Billable
│ │ │ │ └── S31.111S Laceration without fb of abd wall, LUQ w/o penet perit cav, sequela ✅ Billable
│ │ │ │
│ │ │ └── S31.112 Laceration without foreign body of abdominal wall, epigastric region... ❌ Non-billable
│ │ │
│ │ └── S31.12 Laceration with foreign body of abdominal wall... ❌ Non-billable
│ │
│ └── S31.6 Open wound of abdominal wall with penetration into peritoneal cavity ❌ Non-billable

Encounter Specificity

Do not use the “A” extension for routine wound checks or suture removal visits after the initial repair has been completed. Post-repair follow-ups should be coded with the “D” extension (B), such as S31.111D.

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✅ Includes

The following clinical terms and scenarios map to S31.111A when documented:

• Knife cut to the left upper abdomen (superficial or muscular, not deep)

• Tearing of the LUQ abdominal skin and fascia without retained dirt/glass

• Active ED management and closure of a left upper quadrant abdominal cut

• Laceration of LUQ abdominal wall NOS

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❌ Excludes

Excludes 1 — Cannot Be Coded Simultaneously with S31.111A

Code	Description	Note
S31.121A	Laceration with foreign body of abdominal wall, left upper quadrant without penetration into peritoneal cavity, initial encounter	Mutually exclusive; a specific wound cannot simultaneously be “with” and “without” a foreign body.
S31.131A	Puncture wound without foreign body of abdominal wall, left upper quadrant without penetration into peritoneal cavity, initial encounter	Puncture wounds (piercing mechanism) are coded separately from lacerations (tearing/slicing mechanism).

Excludes 1 Violation Risk

A common error is coding both a laceration and a puncture wound for the exact same injury site if the documentation uses the terms interchangeably. Choose the code that best fits the mechanism described by the physician, or query for clarification.

Excludes 2 — May Be Coded in Addition if Separately Present

Code	Description	Note
S31.611A	Laceration without foreign body of abdominal wall, left upper quadrant with penetration into peritoneal cavity, initial encounter	Usually mutually exclusive for the same wound, but allowable as an Excludes2 if there are multiple separate lacerations in the LUQ, some penetrating and some not.
S30.811A	Abrasion of abdominal wall, left upper quadrant, initial encounter	May be coded concurrently if an abrasion is present adjacent to, but separate from, the laceration.

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📋 Clinical Overview

Injury Type and Depth Distinction

Accurate selection depends heavily on verifying both the quadrant and the depth of the injury.

Feature	S31.111A — W/O Penetration	S31.611A — With Penetration	S31.121A — W/ Foreign Body
Depth of Injury	Confined to skin, subcutaneous fat, and muscle.	Pierces the parietal peritoneum, exposing the intra-abdominal cavity.	Confined to abdominal wall, but with retained material.
Clinical Finding	Fascia may be visible, but no bowel or omentum is seen.	Evisceration of omentum/bowel, or direct visualization into the abdomen.	Dirt, glass, or fragments are embedded inside the wound.
Surgical Action	Local exploration, irrigation, and layered closure.	Often requires diagnostic laparoscopy or exploratory laparotomy.	Requires formal exploration and foreign body extraction prior to closure.

Documentation Tip — Depth Verification

Ensure the provider clearly documents the depth of the abdominal laceration. Vague documentation like “deep cut to left upper abdomen” is insufficient. The record must specify whether the wound violated the peritoneum. If absent, a CDI query is necessary to confirm the depth.

Common Diagnoses / Clinical Indications

This code is typically accompanied by an external cause of injury code to explain the mechanism:

• Accidents: Falls onto sharp objects or accidental cuts with tools.

• Assaults: Stabbings or slashings during an altercation.

• Self-Harm: Intentional cutting.

Coding Manifestations (External Causes)

Always code the external cause, place of occurrence, and activity for traumatic injuries. Examples include:

• W26.0XXA — Contact with knife, sword or dagger, initial encounter

• Y04.0XXA — Assault by unarmed brawl or fight, initial encounter

• Y92.009 — Unspecified place in unspecified non-institutional (private) residence as the place of occurrence of the external cause

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💰 HCC Risk Adjustment (CMS-HCC v28)

Field	Detail
CMS-HCC Model Version	v28 (2024-2025 Implementation)
HCC Assignment	❌ Not HCC-Mapped
HCC Category	N/A
RAF Coefficient	N/A

S31.111A does not map to an HCC under v28.4

Capture Annually

As an acute initial encounter code, it does not carry over year-to-year. However, it is essential for the prompt adjudication of claims in emergency and trauma settings.

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🏥 DRG Assignment

MDC 09 — Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast

DRG	Title	Est. Relative Weight*
DRG 604	Trauma to the skin, subcutaneous tissue and breast with MCC	~1.45 - 1.65
DRG 605	Trauma to the skin, subcutaneous tissue and breast without MCC	~0.85 - 0.95

_Approximate. Verify against IPPS FY2026 Final Rule tables._5

Sequencing and Complications

If the patient is admitted primarily for observation or closure of the LUQ abdominal wall laceration, S31.111A acts as the principal diagnosis. However, if the patient has other major internal trauma (like a splenic laceration from blunt force), the internal injury is sequenced first, which typically drives the case into MDC 06 (Digestive System) or MDC 24 (Multiple Significant Trauma).

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🔗 Related ICD-10-CM Codes

Encounter and Quadrant Variants

Code	Description
S31.111A	Laceration without foreign body of abd wall, LUQ w/o penet perit cav, initial ← This Code
S31.110A	Laceration without foreign body of abd wall, RUQ w/o penet perit cav, initial
S31.111D	Laceration without foreign body of abd wall, LUQ w/o penet perit cav, subs

Injury Type Variants

Code	Description
S31.121A	Laceration with foreign body of abd wall, LUQ w/o penet perit cav, initial
S31.611A	Laceration without foreign body of abd wall, LUQ with penet perit cav, initial

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🛠️ Commonly Associated CPT Codes (Emergency / Profee)

Outpatient and Profee Setting Context

For abdominal wall lacerations, the CPT code selection is driven by the length of the wound (in centimeters) and the complexity of the closure (Simple, Intermediate, Complex).

CPT Code	Description	Profee Coding Notes
12001	Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less	Used for single-layer closure of the epidermis/dermis on the trunk/abdomen.
12002	Simple repair… 2.6 cm to 7.5 cm	Used for longer simple repairs on the abdomen.
12032	Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities; 2.6 cm to 7.5 cm	Requires layered closure of deeper subcutaneous tissue in the abdominal wall.
13101	Repair, complex, trunk; 2.6 cm to 7.5 cm	Used for extensive undermining, stents, or complex layered repair of the abdominal wall.

NCCI Bundling Considerations

• Wound Debridement (e.g., 11042) billed on the same day as an intermediate or complex repair (12032, 13101) is usually bundled. Debridement of the wound edges to facilitate closure is considered included in the repair CPT code unless the debridement is performed on a distinct, separate lesion.

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🔬 ICD-10-PCS Crosswalk (Inpatient Procedures)

When S31.111A is an inpatient diagnosis requiring surgical intervention, these PCS codes reflect the most likely procedures.

PCS Section	Body System	Root Operation	Clinical Application
0 (Medical and Surgical)	H (Skin and Breast)	Q (Repair)	Suturing a superficial laceration of the left upper abdomen; e.g., 0HQ70ZZ (Repair Abdomen Skin, Open Approach).
0 (Medical and Surgical)	J (Subcutaneous Tissue and Fascia)	Q (Repair)	Layered closure involving abdominal fascia; e.g., 0JQ80ZZ (Repair Abdomen Subcutaneous Tissue and Fascia, Open Approach).

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💊 Coding Scenarios and Examples

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Scenario 1 — Emergency Department: Accidental Laceration

Clinical Vignette: A 42-year-old female presents to the ED after accidentally cutting her left upper abdomen with a utility knife while opening boxes. The physician evaluates the 4 cm laceration, notes that it involves the skin and superficial subcutaneous fat but does not reach the fascia. The wound is irrigated, confirmed to have no foreign bodies, and closed with 6 simple interrupted sutures.

CPT / HCPCS (Profee):

• 12002 — Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities; 2.6 cm to 7.5 cm

ICD-10-CM:

• S31.111A — Laceration without foreign body of abdominal wall, left upper quadrant without penetration into peritoneal cavity, initial encounter

• W26.0XXA — Contact with knife, sword or dagger, initial encounter

• Y92.009 — Unspecified place in unspecified non-institutional (private) residence as the place of occurrence of the external cause

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Scenario 2 — Inpatient: Assault with Deep Abdominal Cut

Clinical Vignette: A 28-year-old male is admitted following an assault where he was slashed across the left upper abdomen with a machete. The 10 cm laceration extends deeply through the rectus abdominis muscle but does not violate the posterior fascia or peritoneum. In the OR, the surgeon performs an extensive washout and complex, multi-layered repair of the muscle, anterior fascia, and skin.

Principal Diagnosis:

• S31.111A — Laceration without foreign body of abdominal wall, left upper quadrant without penetration into peritoneal cavity, initial encounter (Reason for admission/surgery)

Secondary Diagnoses:

• Y08.09XA — Assault by strike by other specified object, initial encounter

MS-DRG Assignment: Groups to DRG 605 (Trauma to the skin, subcutaneous tissue and breast without MCC).

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Scenario 3 — CDI Query: Unknown Depth

Clinical Vignette: The ED physician’s note states: “Patient arrived with a stab wound to the left upper quadrant. 3 cm wound present. Sent to surgery for exploration.” The operative note simply states: “Left upper abdominal wound explored and closed.”

Action / Outcome:

Coding S31.111A based on this documentation is risky, as a “stab wound” taken to the OR often penetrates the peritoneal cavity. The documentation fails to explicitly state whether the peritoneum was intact. The coder must query the surgeon for the depth.

Query Response: The surgeon updates the operative note: “The wound penetrated the abdominal wall into the peritoneal cavity, but no internal organs were injured. Fascia and peritoneum were repaired.”

Corrected ICD-10-CM Coding:

• S31.611A — Laceration without foreign body of abdominal wall, left upper quadrant with penetration into peritoneal cavity, initial encounter (Provides the required specificity for the peritoneal penetration)

• W26.0XXA — Contact with knife, sword or dagger, initial encounter

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⚠️ Coding Pitfalls and Tips

	Pitfall or Tip
❌	Assuming Peritoneal Penetration. Do not code from the S31.6- category (with penetration into peritoneal cavity) unless explicitly documented by the provider. If the depth is ambiguous, query the provider. Defaulting to penetration without documentation can lead to compliance issues.
❌	Missing the External Cause Codes. Failing to assign external cause codes (V, W, X, or Y codes) for acute injuries can result in immediate claim denials, particularly for workers’ compensation or liability claims.
✅	Summing Wound Lengths. For profee coding, if there are multiple lacerations of the same complexity on the trunk (e.g., two simple lacerations measuring 3 cm and 4 cm on the abdomen), you must sum the lengths (7 cm) and bill a single CPT code (e.g., 12002) rather than billing separately.
✅	Follow-Up Encounters. Once the active treatment phase is complete (e.g., the patient returns to the clinic 10 days later for suture removal), switch the 7th character from “A” to “D” (e.g., S31.111D).

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📚 Sources

1. CMS/NCHS. ICD-10-CM Official Guidelines for Coding and Reporting, FY2026.

2. American College of Emergency Physicians (ACEP). Laceration Repair Coding Guidelines.

3. American Hospital Association (AHA). Coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2018. (Guidance on coding penetrating trauma vs superficial wounds).

4. CMS. 2025-2026 Medicare Advantage Risk Adjustment — CMS-HCC Model v28 ICD-10-CM Mappings.

5. CMS. IPPS Final Rule FY2026 — MS-DRG Definitions Manual v43. MDC 09 logic tables.

6. AMA. CPT Professional Edition 2026. Surgery / Integumentary System.