Q: How would you code the following injury; small intraventricular hemorrhage in the third and fourth ventricles with associated obstructive hydrocephalus?

A: The only codes for intraventricular hemorrhage are located within the cerebrum chapter of the dictionary and are listed on page 48 of your dictionary, but the answer will depend upon whether the patient is unconscious. As you can see there are 3 separate codes and if you patient was unconscious for > than 6

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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 low in severity for an injury that was clearly complex,

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Q: A person with a full bladder is struck by a car while crossing the street. He is able to ambulate but experiences severe abdominal pain and faints. In the ED he has low volume hematuria and the FAST scan shows intraperitoneal fluid. He is taken to surgery and repair of a 3cm laceration on the posterior surface of the dome of his bladder is done. Please code this bladder injury.

A: 540625.3 urinary bladder laceration intraperitoneal wall > 2cm This is an OIS grade IV injury

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: Pedestrain struck by vehicle who expires 10 minutes after arrival in ED. No CTs taken. Medical Examiner report: fracture dislocation at C1/C2. Cause of death blunt cervico spinal trauma. Trauma sheets have Trauma Surgeon documentation: 1. Crepitus R femur mid shaft, 2. Obvious open fracture L femur midshaft 3. Distinct crepitus ribs R side 1-6 4. Multiple lacerations/abrasions over back and flank 5. Crepitus and abnormal alignment cervical spine appears to be dislocation with fracture

A: 1. There is nomention of spinal cord injury at all so that cannot be coded even through it is very likely. It appears the cervical injury may be the cause of expiration but there is always the possibility of internal injury not mentioned and an abbreviated examination due to the mechanism. We cannot presume

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