Q: You have a patient with a penetrating knife injury to the extremity that lacerates (only) the muscle. Should you use just the penetrating codes or muscle laceration under skin subcutaneous tissue. Is this a blunt or penetrating injury?

A:This is considered penetrating trauma and you would code penetrating trauma using the penetrating injuries section. If you look at the rule box above the skin subcutaneous muscle section it identifies that you should code blunt soft tissue injury in that section.

Q: Have the following finding on a patients MRI – “œsmall epidural hematoma from C7-T1 which is likely emanating from the compression fracture of T1″ ““ He does not have a C7 fracture. What would you code especially considering it involves the cervical and thoracic spine?

A: You should code the epidural at the highest level (C7) unless you have evidence of deficit at a lower level. You may not “double dip” and code the epidural again in the T-spine. Again, if there is no deficit, code 640200.3 for the epidural hematoma and 650430.2 for the compression fracture of T 1.

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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: 56 yr old admitted to the ED with documentation of 15% second and third degree burns to her chest and bilateral arms. Two days later Burn specialist documentation states patient has 30% second and third degree burns to same body regions. What is the most accurate code for this injury

A: Code 912024.4 30% patient is older than 5 years. Burns can appear less severe at the time of incident but can evolve in degree and extent so the Burn specialist documentation should be most accurate in this case

Q: The patients arrives after a MVC in which their chest and neck were pinned between the seat and the steering wheel for a period of time; After all the scans are complete, a diagnosis of asphyxia from loss of airway while trapped is given. At 24 hours, she is awake and alert with no neurologic deficits. How would you code this injury? To what ISS body region is this severity assigned?

A: Asphyxia, although a sequelae of injury, is codeable when it is the direct result of the trauma. The code is found in the external and other trauma chapter of the dictionary. Code: 020002.3 and assign to the head body region for ISS.

Q: A burn patient arrives in the ED after being involved in a house fire where she was removed from the bedroom engulfed in smoke and unresponsive. The initial evaluation included intubation, a carbon monoxide level and ABG showing pO2 60 mmHg. In addition, a bronchoscopy was done to assess the airways. The results were positive carbonaceous deposits requiring lavage to clear the airway and erythema with friable membranes.

A: 419206.5; The mechanism of injury implies inhalation burn from breathing the superheated air along with the smoke. Inflammation of the airways, friability with obstruction of the bronchi requiring clearance is evidence of severe inhalation injury; ABG demonstrates hypoxemia as well

Q: Patient arrives after a 20′ fall from a height landing on his right leg; examination shows a visibly shortened RLE; plain film of the pelvis demonstrates that the right iliac wing is higher than the left with apparent SI joint dislocation and fractures of the superior and inferior pubic rami on the right; CT scan confirms a Malgaigne shear fracture of the pelvis; blood loss is not known.

:A: 856171.4; A Malgaigne fracture is a vertical shear fracture with instability and complete separation of one side of the pelvis from the other (disruption of the pelvic ring). If blood loss had been provided, more definition could have been used. However, in this case NFS was the best choice.