ICD-10-CM Code T81.41XA

Infection following a procedure, superficial incisional surgical site, initial encounter

Version 2020 Billable Code

Valid for Submission

T81.41XA is a billable code used to specify a medical diagnosis of infection following a procedure, superficial incisional surgical site, initial encounter. The code is valid for the year 2020 for the submission of HIPAA-covered transactions. The ICD-10-CM code T81.41XA might also be used to specify conditions or terms like postoperative abdominal wall wound abscess, postoperative wound abscess, postoperative wound infection-superficial, stitch abscess, superficial incisional surgical site infection, wound abscess, etc

ICD-10:T81.41XA
Short Description:Infct fol a proc, superfic incisional surgical site, init
Long Description:Infection following a procedure, superficial incisional surgical site, initial encounter

Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

  • Postoperative abdominal wall wound abscess
  • Postoperative wound abscess
  • Postoperative wound infection-superficial
  • Stitch abscess
  • Superficial incisional surgical site infection
  • Wound abscess
  • Wound abscess following procedure

Replacement Code

T8141XA replaces the following previously assigned ICD-10 code(s):

  • T81.4XXA - Infection following a procedure, initial encounter

Code Classification

  • Injury, poisoning and certain other consequences of external causes (S00–T98)
    • Complications of surgical and medical care, not elsewhere classified (T80-T88)
      • Complications of procedures, not elsewhere classified (T81)

Code History

  • FY 2019 - Code Added, effective from 10/1/2018 through 9/30/2019
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020

Information for Patients


After Surgery

After any operation, you'll have some side effects. There is usually some pain with surgery. There may also be swelling and soreness around the area that the surgeon cut. Your surgeon can tell you which side effects to expect.

There can also be complications. These are unplanned events linked to the operation. Some complications are infection, too much bleeding, reaction to anesthesia, or accidental injury. Some people have a greater risk of complications because of other medical conditions.

Your surgeon can tell you how you might feel and what you will be able to do - or not do - the first few days, weeks, or months after surgery. Some other questions to ask are

  • How long you will be in the hospital
  • What kind of supplies, equipment, and help you might need when you go home
  • When you can go back to work
  • When it is ok to start exercising again
  • Are they any other restrictions in your activities

Following your surgeon's advice can help you recover as soon as possible.

Agency for Healthcare Research and Quality


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Wounds and Injuries

An injury is damage to your body. It is a general term that refers to harm caused by accidents, falls, hits, weapons, and more. In the U.S., millions of people injure themselves every year. These injuries range from minor to life-threatening. Injuries can happen at work or play, indoors or outdoors, driving a car, or walking across the street.

Wounds are injuries that break the skin or other body tissues. They include cuts, scrapes, scratches, and punctured skin. They often happen because of an accident, but surgery, sutures, and stitches also cause wounds. Minor wounds usually aren't serious, but it is important to clean them. Serious and infected wounds may require first aid followed by a visit to your doctor. You should also seek attention if the wound is deep, you cannot close it yourself, you cannot stop the bleeding or get the dirt out, or it does not heal.

Other common types of injuries include

  • Animal bites
  • Bruises
  • Burns
  • Dislocations
  • Electrical injuries
  • Fractures
  • Sprains and strains

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