Q: A patient involved in an ATV wreck has multiple facial fractures that do not meet the criteria for a LeFort fracture diagnosis. How should they be coded? The highest AIS severity code for individual facial fractures is .2 and that doesn’t seem to reflect the severity of these multiple fractures.

A: The patient with multiple complex facial fractures that do not meet the criteria for LeFort fractures presents a dilemma for the coder using the AIS 90 Update 98 dictionary. There really isn’t a good option in that version. The IISC has added a new code in AIS 2005 — Panfacial Fracture. Panfacial fracture is defined as “multiple and complex fractures that may involve middle and lower face, upper and middle face, or all three, but not LeFort fractures.” It assigns severity codes of .3 or .4 depending on the amount of associated blood loss. It provides another reason to consider upgrading to AIS 2005.