Penetrating wound w/o foreign body of unsp eyeball, sequela

This code describes a long-term complication or late effect resulting from a penetrating injury to an unspecified eye where no foreign body was retained. This indicates that the initial injury has healed, but residual issues or conditions persist due to the original trauma.

Use this code when documenting a patient presenting with a condition that is a direct consequence of a past penetrating eye wound, and the specific eye (left or right) is not documented. The medical record should clearly link the current condition to the previous penetrating trauma and confirm the absence of a retained foreign body.

• Ensure documentation explicitly states the condition is a "sequela" or "late effect" of a past penetrating injury.
• Avoid using this code for acute injuries; instead, use the appropriate acute injury code with the initial encounter or subsequent encounter seventh character.
• If the specific eye is documented (left or right), select the more specific code (S05.61XS or S05.62XS).