External and Other FAQs

Q: Scenario: Man falls from a ladder while trimming a tree striking the upright post of a mental fence before impact on the ground. 1. Deep 18cm laceration across the abdomen with obvious evisceration of bowel. Exploratory Lap report only describes a 2. serosal tear at the junction of the duodenum and jejunum with a small hematoma. How would you code these injuries?

A: Cannot code evisceration, code the abdomianl laceration as minor laceraton < 20 cm 510602.1, code serosal tear assign to jejunum as partial thickness injry 541422.2 hematoma is part of this injury, Lis Franc injury is a dislocation of tarsometatarsal joints with no...

Q: A patient arrives to the ED with a severe head injury; he is transported to the ICU in anticipation of organ donation and while the brain death evaluation is completed. His final diagnoses include the expected head injury and brain death. What do you do when coding this chart regarding the brain death itself?

A: Brain death is a situation not an injury. The coder would appropriately code the lesions identified on CT as well as any edema. However, brain death is a sequelae of those injuries. Even if the patient had no codeable injuries in the brain, there would still be no...

Q: A patient has an unstable C7 vertebral body fracture, a fractured spinous process at C2 and a subluxation C6/C7 with sensory/motor loss below T2. The CT/MRI states ‘multilevel cord contusion’ (cord contusion at lower cervical and upper dorsal level). At 24 hrs post injury pt remains paralysed and sedated, pt not moving upper and lower limbs prior to intubation. How should these injuries be coded?

A: Code the C2 spinous process with one code (650218.2) and the C6/C7 fx/dislocation with the cord contusion as one code (with complete tetraplegia) as 640228.5. Although the cord contusion is multilevel, you should only code it with the fracture dislocation. If you...

Q: What is the correct code for a closed bimalleolar fracture?

A: The correct code is 854441.2Although there are three codes that mention bimalleolar fracture, the rule box on page 151 of AIS 2005 directs the coder to use this code when the specific anatomic location of the bimalleolar fracture is not known.

Q: An elderly gentleman falls down stairs and sustains an injury to the neck with paralysis of the upper extremities with some movement of the lower extremities. There is a fracture noted at C5. He is diagnosed with central cord syndrome. Over the next several weeks he slowly regains function of his extremities. How would you code this injury?

A: Spinal cord injuries should be coded based on the patient's status at 24 hours. The correct code for this injury is 640214.4 -- cord contusion, incomplete cord syndrome, with fracture.Because the patient does improve, coders frequently want to use the code for...