icd 10 code for hematoma of rectus sheath

What is a rectus sheath hematoma?

Rectus sheath hematoma is an uncommon cause of acute abdominal pain. It is an accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear. It could occur spontaneously or after trauma.

What is the ICD 10 code for abdominal hematoma?

ICD-10-CM Code for Contusion of abdominal wall, initial encounter S30. 1XXA.

What is the correct CPT code for incision and drainage of a rectus sheath hematoma?

If you incise and drain a hematoma, seroma or fluid collection, use CPT 10140. In this procedure, you incise the pocket of fluid and bluntly penetrate it to allow the fluid to evacuate. You can use this code with or without the necessity of packing.

What is the rectus sheath?

The rectus sheath is the durable, resilient, fibrous compartment that contains both the rectus abdominis muscle and the pyramidalis muscle. The fascial coverings of the external oblique, internal oblique, and transversus abdominis muscles comprise the rectus sheath.

What's the difference between a contusion and a hematoma?

A bruise, also known as a contusion, typically appears on the skin after trauma such as a blow to the body. It occurs when the small veins and capillaries under the skin break. A hematoma is a collection (or pooling) of blood outside the blood vessel.

What is abdominal hematoma?

An abdominal hematoma can be intrabdominal or an abdominal wall hematoma. Abdominal wall hematoma usually results from bleeding inside the muscle layers of the abdominal wall, most commonly the vascular rectus muscle. A known category of this hematoma is rectus sheath hematoma.

What causes a hematoma of rectus sheath?

Rectus sheath hematomas (RSHs) are generally caused either by rupture of one of the epigastric arteries or by a muscular tear with shearing of a small vessel.

How do you code a hematoma?

Code Description: The CPT code that would be billed for the procedure is 10140 (Incision and drainage of hematoma, seroma or fluid collection). Lay Description: The physician makes an incision in the skin to decompress and drain a hematoma, seroma, or other collection of fluid.

How do you treat a rectus sheath hematoma?

Conservative treatment of rectus sheath hematoma includes rest; analgesics; hematoma compression; ice packs; treatment of predisposing conditions; and if necessary, more aggressive therapies of intravenous fluid resuscitation, reversal of anticoagulation, and transfusion.

How is rectus sheath hematoma diagnosed?

The best diagnostic modality to evaluate a suspected RSH is an abdominal computerized tomography (CT) scan, which is more specific than ultrasonography. (Abdom Imaging 1996;21:62.) Sonographic findings are nonspecific in some cases, and can mimic abdominal wall tumors and inflammatory diseases.

Where is your rectus sheath?

The rectus sheath is a tendon sheath (aponeurosis) which encloses the rectus abdominis and pyramidalis muscles. It is an extension of the tendons of the external abdominal oblique, internal abdominal oblique, and transversus abdominis muscles.

Is rectus sheath hematoma life threatening?

Rectus sheath hematoma is self-limiting but it can be fatal in older patients. These findings should alert the emergency physician.

What is the ICD 10 code for subcutaneous hematoma?

32 for Postprocedural hematoma of skin and subcutaneous tissue following other procedure is a medical classification as listed by WHO under the range - Diseases of the skin and subcutaneous tissue .

What is the ICD 10 code for pelvic hematoma?

O71. 7 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM O71.

What is the ICD 10 code for right retroperitoneal hematoma?

A: Hemoperitoneum is defined as the presence of blood in the peritoneal cavity that accumulates in the space between the inner lining of the abdominal wall and the internal abdominal organs. Code K66.

What does Hemoperitoneum mean?

Hemoperitoneum, sometimes also called intra-abdominal hemorrhage or intraperitoneal hemorrhage, is a type of internal bleeding in which blood gathers in your peritoneal cavity.

What are the different types of hematomas?

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code: 1 Contusion of abdominal wall 2 Contusion of flank 3 Contusion of groin 4 Contusion, anterior abdominal wall 5 Disorder of rectus sheath 6 Hematoma of abdominal wall 7 Hematoma of groin 8 Hematoma of rectus sheath 9 Traumatic hematoma of abdominal wall

What is the S30.1XXA code?

S30.1XXA is a billable diagnosis code used to specify a medical diagnosis of contusion of abdominal wall, initial encounter. The code S30.1XXA is valid during the fiscal year 2021 from October 01, 2020 through September 30, 2021 for the submission of HIPAA-covered transactions.

How common is rectus sheath hematoma?

Overall, rectus sheath hematoma accounts for only about 1% to 2% of all causes of acute abdominal pain.  [2] In a 2016 review by Sheth et al. evaluating a series of patients with rectus sheath hematoma, women were more likely than men to develop a rectus sheath hematoma, with a ratio of 1.7 to 1. This is consistent with epidemiologic data demonstrated in other studies. The mean age of patients in Sheth’s review was 67 years. The overall mortality rate associated with rectus sheath hematoma is less than 2% in the most recent publications.  [3]

What causes a hematoma in the rectus sheath?

Rectus sheath hematoma occurs as a result of injury to an epigastric artery or its perforating branches within the rectus muscle. Recall that the blood supply to the rectus abdominis muscles originates from the superior and inferior epigastric arteries. The superior epigastric artery arises from the internal thoracic artery and travels caudally within the rectus sheath to anastomose with the inferior epigastric artery. The inferior epigastric artery, deriving from the external iliac, travels cephalad along the posterior surface of the rectus muscle, where it lacks the protection of a posterior rectus sheath until it reaches the arcuate line. The arcuate line is located a third the distance between the umbilicus and the pubic symphysis.  [1]

What is the most valuable laboratory study for rectus sheath hematoma?

The most valuable laboratory studies for the evaluation of rectus sheath hematoma are hemoglobin/hematocrit and coagulation studies. As previously mentioned, over half of patients would be expected to demonstrate a decline in hemoglobin of greater than or equal to 0.4 g/dL. This is neither sensitive nor specific and thus cannot reliably indicate the presence or severity of a hematoma. However, following the trend of serial hemoglobin values can help establish a trajectory for the patient’s course.

What are the risk factors for rectus sheath hematoma?

A few well-documented risk factors are associated with rectus sheath hematoma development. The greatest risk is in those who are therapeutically anticoagulated. In Sheth’s review, almost 70% of patients were on some form of anticoagulation. Naturally, as the prevalence of chemical anticoagulation increases, one may reason that the incidence of rectus sheath hematoma also rises. However, there is a paucity of data in the modern literature to reflect this. In the same series, nearly 60% of patients with rectus sheath hematoma also had chronic kidney disease stage III or greater. Other risk factors, in order of descending prevalence, include abdominal wall injections, steroid or immunosuppressant therapy, cough, femoral puncture, and antiplatelet therapy.  [3]

How much of blood volume is lost in a hemorrhagic shock?

According to the widely accepted classification of hemorrhagic shock, patients generally do not manifest any hemodynamic changes associated with hemorrhage until at least 15% to 30% of blood volume is lost. While this certainly is a possibility in the setting of rectus sheath hematoma, it is the case in only about 1% to 13% of patients.  [4] Thus the absence of these changes, such as tachycardia, hypotension, or orthostasis, should not lessen the clinician’s suspicion for the diagnosis.

Can INR be used for rectus sheath hematoma?

All patients with a suspected rectus sheath hematoma should have baseline coagulation studies at the time of their initial evaluation. Again, a large majority of patients with rectus sheath hematoma are taking some form of therapeutic anticoagulation. For those taking warfarin, the INR can help steer the decision to administer a reversal agent. With the increasing use of antiplatelet therapies and novel oral anticoagulants (NOAC), the INR may be less informative but should still be obtained as part of a coagulation panel.

Is rectus sheath hematoma a hematoma?

Rectus sheath hematoma is a relatively uncommon entity that is most often associated with abdominal wall trauma or anticoagulation. Although it is a well-documented condition, its diagnosis can be difficult given its propensity to mimic a variety of intra-abdominal pathologies.