External and Other FAQs

Q: Where do I code the pars interarticularis

A: This is coded to the pedicle. Anatomically it does lie between the lamina and pedicle, but our neurosurgeon consultants have identified that it is most appropriate to code it to the pedicle.

Q: How do I code Hypothermia?

A: Hypothermia is coded if it is a result of the primary injury, not treatment related or sequel of treatment. The temperature should be taken at your facility and be a core temperature - we would say you don't qualify for "Hypothermia" unless the environmental...

Q: When you start coding with ICD-10, there are many questions that arise. – Do you need to make a decision on how specific you want to be with your code selection? There are many thoughts on coding in trauma systems and you may ask should you code everything as specific as possible? – Or, can you code less specific and perhaps have a more efficient work process for your registrars? – Do very specific codes have an impact on our ISS? In other words, if I code super specific, will my ISS’s be higher?

A: In regard to theses question, we recommend coding as specifically as possible using theAIS Dictionary, and not relying on the computer to identify the codes since they don"t always match and may give you inaccurate AIS conversions and therefore inaccurate ISS...

Q: You review a record where the Orthopaedic surgeon states “the patient has a patellar fracture which looks like an inferior pole and essentially an avulsion of the patellar tendon” The x-ray identifies – “œavulsion of the distal pole of patella with a small fragment of bone left.” How would you code this injury?

A: The infrapatellar component of the extensor mechanism is the patellar ligament, also known as the patellar tendon. The patellar ligament originates at the lower pole of the patella, where it has contributions from the aponeurosis mentioned above, and inserts on an...

Q: How would you code this finding? Acute left parasymphyseal fracture of the left hemi mandible. Fracture of the angle of the right hemi mandible. When reviewing the physician notes they state, “right angle and left parasymphseal displaced mandible fractures.”

A: The mandible is one of the ring – like bony structures that only receives 1 code. You should code it to the largest mass area. As you go down the codes under mandible, they increase in body mass, so you would use the code for symphysis/parasymphysis 250614.2

Q: If your CT reported the following injuries ““ “œRight mandibular condyle, ramus and coronoid process fracture. Complex right maxillary fracture involving the anterior, medial and lateral and superior walls (orbital floor), fracture of right pterygoid plates and orbital fractures involving the apex, lateral, superior and inferior walls with complex fractures of the frontal bone” How would you code this case ?

A This sounds like a panfacial fracture since it involves all 3 regions of the face, and it is not a LeFort. If it involves both sides of the face it would meet the definition of multiple and complex fractures for panfacial. If unilateral, you should code each...

Q: A patient falls down outside during cold weather and cannot get up. They are brought in by EMS with a core temp of 32.5 degrees Celsius and a tibial shaft fracture. What codes would you use and why? Which body regions do you put the codes for ISS calculation and why?

A: Yes there is a hypothermia code in AIS and you would use the code 010004.2, since this is how the patient arrived and is not the result of treatment (or lack thereof) in the hospital. In this case, the hypothermia, would go to the external region for ISS...

Q: When you have a fracture of the tibia and the fracture extends from the shaft into the distal bone how do you code? In this situation, it is one fracture that is branching out over multiple areas of the same bone, not to be confused with multiple separate fractures.

A: One fracture line gets only one code. Think of the most severe or important code you want to capture. If the line extends to the articular surface (an intraarticular fracture) we would code it there. If it just goes into the metaphysis but doesn"t involve the joint...

Q: How do you code a renal artery psuedoaneurysm ?

A: A pseudoaneurysm, also termed a false aneurysm, is a leakage of arterial blood from an artery into the surrounding tissue with a persistent communication between the originating artery and the resultant adjacent cavity.

Q: A patient is found down in an apartment fire without cardiac activity and was resuscitated and transported. She had a bronchoscopy and found to have a mild inhalation injury with elevated carbon monoxide levels. How would you code this injury and why?

A: This would be coded as an inhalation injury. The asphyxia codes do not apply to inhalation injury. Carbon monoxide poisoning is not a codable injury and asphyxia applies to mechanical constriction or restriction of the airway. You may only code the inhalation injury.

Q: I have a patient that had a left vertebral artery dissection. Two days later the patient had an MRI that showed a brain stem infarction. I am not sure if I should code the brain stem infarction, since it didn’t show up until 2 days later and could possibly be caused by the dissection.” What is the correct code for this injury?

A: The correct code for this injury is 321004.3. This was described as a "dissection" in the conclusion of the MRI and the patient had subsequent neurologic deficit (infarcts). The brain "injuries" occurred as a result of the dissection, not direct trauma to the brain...

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...