Q: If Hyperdensities are seen along interhemispheric falx and the tentorium, keeping with acute extra-axial haemorrhage. How and where do we code these?
A: Hyperdensities generally refer to blood and in these areas are usually either SDH or SAH. The falx separates the right side of the cerebrum from the left side and the tentorium separates the cerebrum from the cerebellum. When blood is described as being “along the tentorium” we code it to the cerebrum unless they clearly indicate either cerebellum or that it is “infratentorial” or in the posterior fossa. We always code to cerebrum if we aren”t sure of the location. The correct code is 140629.3 ( Page 45 of AIS dictionary )
Q: Female farm worker got the front of her jacket caught in a piece of farm machinery with complete avulsion of her R chest including the pectoralis muscle down to the exterior ribs from just below her clavicle to the level of last rib, no rib fractures evident but over 2000cc blood loss from transected mammary artery. Please code these injuries.
A: 411000.2 breast avulsion female, 410102.2 pectoral muscle laceration, 422008.3 transected mammary artery with > 20% blood loss
Q: Passenger involved in an MVC arrives c/o neck pain; a CT of the neck demonstrates a C6 fx through the transverse foramina; as a result, a CTA was done with identifies a complete occlusion of the vertebral artery at the level of C6 and corresponding the the side of the fracture; How would you code this VASCULAR injury?
A: The vertebral artery is frequently injured at the level of the cervical spine fracture; the srtery traverses the transverse foramina and is vulnerable at this point, thus the CTA examination. Code: 321018.3
Q: Your newest trauma patient has suffered a basilar skull fracture. While reading the CT scan of the head, you notice that there is also a dislocation of the ossicles on othe left. After coding the basilar skull fracture correctly, you are left with a decision about the ossicular dislocation. How do you code this specific injury?
A: 240212.1; the ossicles are seen on CT scan but they are the skeletal component of of the ear. Thus, the AIS code for the ossicles is found in the face, under the organ “ear”. This injury is frequently associated with a basilar skull fracture, which would be coded separately. The patient is likely also demonstrating issues with hearing on the left where the ossicles are dislocated.
Q: A patient sustains bilateral lacerations to the internal iliac arteries. What is the correct code for this injury?
A: The bilateral code in the AIS dictionary refers specifically to the common iliac artery. In this case the two internal iliac artery injuries would be coded separately, using 520604.3 for the left and the right internal iliac arteries.
Q: If patient has a stab wound of the thigh extending into muscle (but not bone), what is the correct code and should it be assigned to the External ISS body region or the Extremity ISS body region?
A: The correct code is 816014.1 and the injury is assigned to the External ISS body region. Although the dictionary does inclue specific codes for muscle injuries in the Extremities chapters, those codes are intended for blunt injury. Penetrating injuries to the extremity that do not include injuries to specific underlying structures such as vessels or bone should be coded using the penetrating codes and assigned to the External body region for ISS purposes. The same rule for penetrating injuries applies to other regions of the body as well, with a few exceptions as noted in the AIS 2005 dictionary in the Head and Face chapters.
A: In AIS 98 the correct code is 851612.2
In AIS 205 the correct code is 854465.2
Note that the early editions of AIS 2005 did not include this code. Over the last several months, there have been several additions and corrections. Please refer to www.aaam1.org/ais and click on Updated Pages to download the latest updates to your AIS 2005 dictionary.
Q: A 24 year old male is admitted after a fight. His facial CT demonstrates multiple linear fractures of the mandible, including L condyle, L body and R ramus. There is a deep laceration overlying the left portion of his jaw. The fractures are described as minimally displaced. How would you code these injuries?
A: These injuries present something of a dilemma. The rules and guidelines that apply include: Code bilateral mandible fractures as a single injury. Displacement must be significant (guideline added to AIS 2005 dictionary). With open fractures, do not code the overlying skin injury. The best choice is to use 250610.2. Open/displaced/comminuted but NFS as to site. Note that even though the displacement is minimal, the code is chosen for the open fracture rather than displacement.
Q: If a 1-year-0ld patient sustains TBSA 21% burns of 2nd degree with face involvement, what is the correct code to use?
A: There are two correct answers for this question in AIS 98. The code 912020.4 indicates burns to a child less than 5 years of age. The code 912022.4 indicates facial involvement. It is up to the coder to decide which of the two is more important to note their choice of code. Note that the severity code (4) is the same.
AIS 2005 eliminates the confusion by removing the descriptors for face/hand/genitalia involvement.
[Special thanks to Claire Adorjan-Byrne for this month’s submission.]