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, but it”s the best AIS has to offer.