Q: The autopsy describes the following injuries from blunt trauma to the chest: “There is a 6 inch by 12 inch open wound below the left axilla with portions of the left chest missing, with underlying multiple left rib fractures and portions of ribs 3-8 missing.” How should these be coded?

A: Thanks to everyone who participated this month. Roberta, Jo and Paula all had interesting answers. The answer we were looking for is 451022.5. This is a new code in AIS 2005. Since this is only described as a chest injury we cannot use the “Whole body (explosion-type) injury” code. As for figuring the percentage of the chest involved, I envision the front and back portions as 50% each, and one half of the front to be 25%. With 6 ribs missing and such a large injury described, it seems reasonable to use the “major, > 15% of chest wall including rib cage”.