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Q: A child is admitted to the ED after playing on the trampoline where another child landed on him. Xrays are done and a navicular fracture is identified. Please code this injury
A: This fracture requires more information as to whether or not this is a tarsal or a carpal bone; In an actual clinical situation, the physical examination and xray would b labeled as wrist or foot; If this is a tarsal navicular fx then the appropriate code would be...
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...
Q: A trauma activation is called for a patient with a GSW to the lower abdomen. Immediate laparotomy is undertaken and a perforation to the sigmoid colon identified. The sigmoid is resected, colostomy placed, and the patient moves to the ICU. Please code this abdominal injury
A: The sigmoid is part of the colon and therefore coded to the "colon" in the abdomen chapter. A perforation is identified. The injury should not be coded any more severely just because the sigmoid was resected. Code:540824.3
Q: A patient is admitted after an assault with a baseball bat to the head; among his injuries, a tympanic membrane rupture; How do you code this injury?
A: a tympanic membrane rupture is coded as 240216.1; note that frequently this injury is also associated with a basilar skull fracture so look for that on the CT scan or a clinical diagnosis of such.
Q: Patient arrives after a fall down a flight of outdoor stairs. The patient experiences an unknown period of exposure prior to being found and brought to the ED. The initial core temperature on arrival is 90.1 degrees Fahrenheit; What would you do with this information?
A: A tempreature of 90.1F is equivalent to a temperature of 32.3 C and therefore meets criteria for the hypothermia code 010004.2; this is not induced for medical treatment but rather from exposure and is included as an injury.
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: Motocross collision, wearing helmet; multiple soft tissue injuries; no other injury identified.
A: 910000.1; Since the skin injuries are not clearly defined, the external "soft tissue injury NFS" code is the best choice; even if the site of injury was known, this is the best code since the type of soft tissue injury is not provided.