Q: When you have a fracture of the tibia and the fracture extends from the shaft into the distal bone how do you code? In this situation, it is one fracture that is branching out over multiple areas of the same bone, not to be confused with multiple separate fractures.

A: One fracture line gets only one code. Think of the most severe or important code you want to capture. If the line extends to the articular surface (an intraarticular fracture) we would code it there. If it just goes into the metaphysis but doesn”t involve the joint surface, code to the shaft.

Q: A patient is found down in an apartment fire without cardiac activity and was resuscitated and transported. She had a bronchoscopy and found to have a mild inhalation injury with elevated carbon monoxide levels. How would you code this injury and why?

A: This would be coded as an inhalation injury. The asphyxia codes do not apply to inhalation injury. Carbon monoxide poisoning is not a codable injury and asphyxia applies to mechanical constriction or restriction of the airway. You may only code the inhalation injury.

Q: I have a patient that had a left vertebral artery dissection. Two days later the patient had an MRI that showed a brain stem infarction. I am not sure if I should code the brain stem infarction, since it didn’t show up until 2 days later and could possibly be caused by the dissection.” What is the correct code for this injury?

A: The correct code for this injury is 321004.3. This was described as a “dissection” in the conclusion of the MRI and the patient had subsequent neurologic deficit (infarcts). The brain “injuries” occurred as a result of the dissection, not direct trauma to the brain stem.

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