Q: A motorcyclist crashes and sustains 15 % partial and full thickness “œroad rash” in addition to multiple lower extremity fractures. Following operative treatment of his fractures he is transferred to the Burn Unit for management of his skin injuries. How should the skin injuries be coded?

Feb 1, 2009 | Extremities | 0 comments

A: Although the skin injuries are being described in terms usually used for burns, the correct codes to use are the abrasion codes. If you know the precise location of the abrasions, we recommend using the Whole Area abrasion codes in each chapter. The code 9xxxxx.1 for multiple abrasions found in the External and Other

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Q: A patient sustains a basilar skull fracture, fractured L zygoma and a nasal fracture. She has bilateral periorbital ecchymosis. There is no mention in the chart of cerebral spinal fluid (CSF) leak. How would you code the basilar skull fracture?

Oct 1, 2008 | Extremities | 0 comments

A: The correct code is 150202.3. If the patient has a CSF leak, the treating physician(s) will always mention it in the chart. When there is no mention of CSF leak, the coder may use the “without CSF leak” code. The periorbital ecchymosis could be due to the nasal fracture and is not necessarily a

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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?

Aug 1, 2008 | Extremities | 0 comments

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

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Q: What is the correct code for the diagnosis “Subdural hematoma 7mm thickness”?

Jun 1, 2008 | Extremities | 0 comments

A: The correct code is 140652.4. If the specific region of the brain (brain stem, cerebellum or cerebrum) is not indicated, the injury should be assigned to the cerebrum.

Q: The patient’s injury is described as a ‘fractured’ larynx. What is the correct code?

Apr 1, 2008 | Extremities | 0 comments

A: Thanks to Abbie, Jo and Hideo for participating in this month”s question. The correct code to use for this injury description is 340208.3. If the larynx is described as “crushed” the code 340212.5 would be appropriate.Because this is a relatively common description for some laryngeal injuries, we are adding the word “fracture” to this

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Q: How can a coder decide if a fracture is extra-articular, partial articular or articular?

Mar 1, 2008 | Extremities | 0 comments

A: The Orthopaedic Trauma Association offers a very helpful guide which includes definitions and drawings which may be helpful to the coder when comparing radiologic descriptions from the chart to the definitions in the AIS 2005 dictionary. Go to http://www.ota.org/compendium/intro.pdf to see this reference.

Q: The patient’s CT demonstrates blood in the maxillary sinuses following blunt facial trauma. How is this coded?

Nov 1, 2007 | Extremities | 0 comments

A: The coder should look for evidence of maxillary or maxillary sinus fractures, but the information we have is insufficient for coding an injury here.

Q: The patient expired immediately from blast injuries which have, in addition to multiple other injuries, transected the spinal cord at the level of C5. How should the spinal cord injury be coded?

Sep 1, 2007 | Extremities | 0 comments

A: The correct code is 640261.5. Although we do not have specific information about paralysis, by definition “transection” means complete transection, and complete transection of the spinal cord results in paralysis, so the injury is coded as a complete cord syndrome.

Q: A patient with diffuse axonal injury (DAI), confirmed by both clinical and radiologic evidence, also has an intraventricular hemorrhage and subarachnoid hemorrhages. This patient remained unconscious from the time of the insult until discharge from the ICU 7 days after admission. How would you code the intraventricular hemorrhage and subarachnoid hemorrhages in AIS 2005?

May 1, 2007 | Extremities | 0 comments

A: These injuries should not be coded. DAI is an example of a global injury which may or may not be accompanied by other radiologic findings. A clarification for coding DAI is now included on page 40 in the Updated Pages found at www.aaam1.org/ais .

Q: The patient ingested Draino and Tilex and has a mild caustic injury to the take-off of the LUL and LLL of the respiratory system. Patient also has a grade II injury (friable) to the esophagus and grade III injury (deep ulcers) to the stomach and pylorus. How should these injuries be coded and what is the ISS?

Jun 1, 2006 | Extremities | 0 comments

A: AIS 98: Bronchus distal to main stem, partial thickness injury – 440206.2ISS = 13 AIS 2005: Bronchus distal to main stem, partial thickness injury – 440206.2Esophagus partial thickness ingestion injury – 440807.3Stomach ulcers (also a partial thickness ingestion injury) – 5444153ISS = 18Note that the codes change slightly in AIS 2005 because we have

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