Q: What is the best AIS code for an open, totally unstable pelvic fracture with blood loss greater than 20%?
A: It really depends on what you want to capture. 856173.5 indicates the blood loss. 856174.5 indicates the fact that the fracture is open. The severity here is the same. It is different for partially unstable fractures so in that case you might lean toward the blood loss which is a higher severity.
Q: Rib fractures quite frequently do not show on chest x-ray and are diagnosed on based on clinical findings. Several sources confirm this. Can we code rib fractures when we have negative imaging but confirmed physician diagnosis?
A: Even if the MD diagnoses rib fx, the AIS rules clearly state that they must be substantiated by radiology/surgery in living patients.
A: A retrosternal hematoma is the result (sequela) of some other injury to the chest, most commonly a fracture of the sternum. It is one of the sequelae of injury that has no code in the AIS dictionary.
Q: Apneic with GCS of 3 at scene. Bullet entry in the occipital region of the skull with trajectory down and forward with exit at the throat. CT shows massive damage of the cerebrum, cerebellum, and brain stem along the bullet pathway Please code the brain injury.
A: No matter how many regions of the brain are involved in a penetrating injury if the brain stem is involved you code the injury as 140216.6 must have CT, MRI or other evidence
Q: A baseball player was accidentally struck in the throat by a hard swung bat. He had immediate pain and difficulty speaking. In the ED a laryngotracheoscopy was performed with diagnosis of nondisplaced fracture of the larynx with vocal cord contusion and edema. Please code this injury.
A: Code 340210.4 the vocal cord involvement raises the severity level of this injury
Q: Driver of a motorcycle without a helmet is struck by a large truck on the highway. He arrives with a GCS 4 and has the usual workup with a CT-head that does not demonstrate any injury. He remains in coma for several days and undergoes an MRI which clearly identifies diffuse axonal injury (DAI) located at the corpus callosum; How would you code this injury and what is your rationale for the choice?
A: Because of the length of coma, the DAI is coded from the concussive section of the head chapter even though we know it is located at the corpus callosum. The coma is consistent for > 24 hours with the MRI appropriately done to confirm the diagnosis and reason for prolonged coma. Code: 161011.5
Q: 36 y.o. female is running across the highway and struck by a vehicle at high speed; she is unresponsive at the scene and has an immediate CT-head which identifies a large bleed likely at the sagittal sinus; Operative craniotomy revealsa laceration to the sagittal sinus with a 2000ml blood loss; the injury is irreparable; How do you code this injury?
A: sadly the blood loss, although massive, cannot be attached to this injury specifically and laceration is the only available code. Code: 122402.4
Q:You receive a patient with a stab wound to the chest. He says it was a short knife. The wound is actively bleeding. Examination and CXR are negative for pneumothorax, however the patient’s blood pressure is dropping. In the OR a transection of the internal mammary artery is evident and repaired.
A: 422008.3; the internal mammary artery is found under “other named arteries” in the chest; a transection is a major injury; even without blood loss information, major is the correct choice. Just a review of terms – in the dictionary the separator “;” means “or” so that each of the components listed under major is not required but any of them being present is enough to qualify for this code
A: KN refers to Drs. Knight and North who described a grading system for the type and amount of displacement of zygomatic fractures. The Knight North scale describes increasing severity from I to VI.
Q: The patient has sustined a single gun shot wound to the head with penetration greater than 2 cm into the right temporal lobe. In addition, he has an associated large subdural hematoma over the right parietal lobe. How would you code these findings?
A: All injuries associated with a gunshot wound to the head are coded as one injury. In this case the correct code is 116004.5 (Penetrating Injury to Skull, major â€“ Whole Area) or 140692.5 (Penetrating Injury to Cerebrum > 2 cm deep) since we know it is in the temporal lobe. In the case of penetrating injuries to other body regions all underlying injuries are coded separately, however penetrating injuries to the head are coded as one entity unless the coder is sure that the other injuries are not related to the penetrating injury. The best analogy is that of crush injury, where bone, soft tissue and vascular injuries are coded as one entity. Congratulations to Jo for her code and thanks to Paula and Delia for illustrating the many ways that coders often approach these difficult injuries.