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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: What is a torn septum pellucida and which code would you use if there was as associted IVH?
A: From what we can tell the septum pellucida is the structure that separates the anterior horns of the lateral ventricles, so when it is torn we would expect to see intraventricular hemmorage. The faculty seems to agree that the cerebral laceration should be coded...
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: What is a vomer bone and where is it coded?
A: Gray's Anatomy lists the vomer as one of the facial bones. Specifically it is the posterior part of the nasal septum. So the code would be 2510006.2.
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...
Q: Is there anywhere that entrapment of extraocular muscles (with orbital fxs) should be coded?
A: Code the orbital fracture based upon the type and place of the fracture. Entrapment is an outcome and is not coded.
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.
Q: How do you code a large abdominal wall hernia on the R side of the abdomen (NOT the Rectus Abdominus muscle) with a 15 cm fascial defect that required open operative management to close. The skin was intact. This was a seatbelt injury in a 12 yr old.
A: This should be coded as 510602.1. This is a "skin" code (assigned to the External ISS body region) and includes subcutaneous and muscle lacerations or tears. Although the outer skin was intact, clearly there was damage below the surface. I realize this seems quite...
Q: A patient fell and now has a significant traumatic pleural effusion as their only injury. How would you code this?
A: Traumatic pleural effusion is a consequence or sequela of injury. It is not listed in the AIS dictionary and is therefore not codable in AIS.
Q: If you have a penetrating injury to the upper extremity that involves > 20% blood loss from the brachial artery should you use the Penetrating Injury with blood loss code (716006.3), or should you code only the artery laceration (720608.3), or should you code both?
A: The rule for penetrating injuries is to code the underlying injury(ies) when known. In this case, code only the brachial artery 720608.3.
Q: If there is a cerebral hemorrhage NFS and LOC of some duration, how can this be coded? May we use concussive injury codes in addition to the hemorrhage code?
A: Do not code coma in addition to the hemorrhage. When there is an anatomic brain injury the concussive codes are not used additionally. If the only injury is a skull fracture (no damage to the brain substance) and there is documented LOC you may use the concussive...
Q: On page 67 of the AIS 2005 Manual, the last code 321021.5 has “œbilateral” as descriptor. Does “œbilateral” mean “œbilateral thrombosis” or “œbilateral neurological deficit”? We have a patient who sustained bilateral vertebral artery dissection and thrombosis with left PCA territory infarction. CT scan states” Apparent migration of intraluminal thrombus arising from the left vertebral artery, resulting in occlusion of the calcarine branch of the left posterior cerebral artery” How should we code this case?
A: Artery dissections are coded under intimal tear and we do not have a code for bilateral under intimal tear. I would code 321004.3 for the left vertebral artery with its subsequent PCA infarction, and 321002.2 for the right side.
Q: A patient is found down in PEA in a burning house. Soot in airway, but no burns in mouth or airway when intubated by Medics. Prolonged CPR, then a rhythm for a short period of time, then PEA. Pupils fixed, dilated, 3T, no response to pain, movement, etc. Minimal partial thickness burns. Can I code asphyxia for her? Her carboxyhemoglobin level was 13.8. Can I code inhalation injury as well?
A: We aren't allowed to code based on carboxyhemaglobins... just the observed airway stuff for inhalation. Asphyxiation is reserved for things like hanging and strangulation... sort of the more mechanical side. So we use inhalation only and the best code is for minor...
Q: How should one code “retrosternal hematoma”?
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: According to Organ Injury Scaling (OIS) guidelines in many cases you may advance one grade for multiple lacerations of an organ. (“œAdvance one grade for multiple injuries to same organ up to Grade III.” AAST) How should multiple Grade II liver lacerations be coded in AIS?
A: Although the Organ Injury Scale allows one to assign a higher grade for multiple lacerations to an organ, the AIS does not allow that for our coding. Multiple Grade II liver lacerations should be coded as 541822.2.
Q: What is the correct code for a zygomatico-maxillary complex (ZMC) fracture?
A: The zygomatico-maxillary complex (ZMC) describes the are which includes the zygomatic arch where it joins the maxilla and the frontal skull. It describes a region of the face and is not a description of the severity of the fracture. The correct code is 251800.1.
Q: How do you code traumatic pleural effusion?
A: Traumatic pleural effusion is a consequence, or sequela, of injury and cannot be coded. Remember that only those sequelae listed in the AIS Dictionary may be coded- if you can't find it, you can't code it.
Q: Child got under the kitchen sink ingesting a variety of caustic agents, vomiting induced immediately but chemical burn and sloughing of esophageal lining documented. No gastric injury evident. Please code this injury
A: The actual region of the esophagus injured is not stated as thorax( below the sternal notch) or to the neck so the default code is to the neck region. This is an ingestion injury with partial thickness necrosis, the sloughing of the lining of the esophagus, 340104.3