Q: Elderly patient after fall down the stairs with MRI showing cord compression due to traumatic spondylolisthesis at L5 on S1. Patient is in severe pain and scheduled for surgery. Please code this spinal injury

A: Only when there is evidence of a codeable cord injury associated with the spondylolisthesis would you code this injury which is actually a slippage of one vertebrae on another. For the spine this is coded as a dislocation with the cord compression of first consideration leading the code selection Code 640606.3 Thank you to

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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 mention of fracture, cartilage involvement or ligament injury so code 878030.1

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 code to apply for the brain

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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 had a second, discrete area of contusion in another place on the

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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 transient injuries rather than the correct code for incomplete cord syndrome.