Q: How do I code Hypothermia?

A: Hypothermia is coded if it is a result of the primary injury, not treatment related or sequel of treatment. The temperature should be taken at your facility and be a core temperature – we would say you don’t qualify for “Hypothermia” unless the environmental temperature is low and causes chilling that requires additional treatment

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Q: When you start coding with ICD-10, there are many questions that arise. – Do you need to make a decision on how specific you want to be with your code selection? There are many thoughts on coding in trauma systems and you may ask should you code everything as specific as possible? – Or, can you code less specific and perhaps have a more efficient work process for your registrars? – Do very specific codes have an impact on our ISS? In other words, if I code super specific, will my ISS’s be higher?

A: In regard to theses question, we recommend coding as specifically as possible using theAIS Dictionary, and not relying on the computer to identify the codes since they don”t always match and may give you inaccurate AIS conversions and therefore inaccurate ISS scores. The AIS book is the most reliable reference.

Q: You review a record where the Orthopaedic surgeon states “the patient has a patellar fracture which looks like an inferior pole and essentially an avulsion of the patellar tendon” The x-ray identifies – “œavulsion of the distal pole of patella with a small fragment of bone left.” How would you code this injury?

A: The infrapatellar component of the extensor mechanism is the patellar ligament, also known as the patellar tendon. The patellar ligament originates at the lower pole of the patella, where it has contributions from the aponeurosis mentioned above, and inserts on an anterior prominence of the proximal tibia, the tibial tubercle.The correct answer would be

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Q: How would you code this finding? Acute left parasymphyseal fracture of the left hemi mandible. Fracture of the angle of the right hemi mandible. When reviewing the physician notes they state, “right angle and left parasymphseal displaced mandible fractures.”

A: The mandible is one of the ring – like bony structures that only receives 1 code. You should code it to the largest mass area. As you go down the codes under mandible, they increase in body mass, so you would use the code for symphysis/parasymphysis 250614.2

Q: If your CT reported the following injuries ““ “œRight mandibular condyle, ramus and coronoid process fracture. Complex right maxillary fracture involving the anterior, medial and lateral and superior walls (orbital floor), fracture of right pterygoid plates and orbital fractures involving the apex, lateral, superior and inferior walls with complex fractures of the frontal bone” How would you code this case ?

A This sounds like a panfacial fracture since it involves all 3 regions of the face, and it is not a LeFort. If it involves both sides of the face it would meet the definition of multiple and complex fractures for panfacial. If unilateral, you should code each fracture individually. If the frontal bone fractures

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Q: A patient falls down outside during cold weather and cannot get up. They are brought in by EMS with a core temp of 32.5 degrees Celsius and a tibial shaft fracture. What codes would you use and why? Which body regions do you put the codes for ISS calculation and why?

A: Yes there is a hypothermia code in AIS and you would use the code 010004.2, since this is how the patient arrived and is not the result of treatment (or lack thereof) in the hospital. In this case, the hypothermia, would go to the external region for ISS calculation and the tibia fracture (854221.2)

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