AAAM AIS Questions

May Question of the Month

admin — Tue, 01 May 2012 07:00:10 +0000

Q: A person with a full bladder is struck by a car while crossing the street. He is able to ambulate but experiences severe abdominal pain and faints. In the ED he has low volume hematuria and the FAST scan shows intraperitoneal fluid. He is taken to surgery and repair of a 3cm laceration on the posterior surface of the dome of his bladder is done. Please code this bladder injury.

April Question of the Month

admin — Sun, 01 Apr 2012 07:00:06 +0000

Q: MVC with man trapped at the Left knee by the dashboard. Upon extrication he has gross deformity at the knee with large blood loss and no sensation or movement in the L lower leg, no pedal pulse. Diagnostics indicate open severely comminuted distal L femur fracture with all ligaments in disruption to the knee. There is also an open midshaft fracture of the left tibia. An above the knee amputation was done on day 2. Please code the L lower extremity injuries
A: Code the injury at the L knee as a crush injury at or above the knee code 813002.4, bone, soft tissue, vascular and nerve were all involved. You would also code the open L mid shaft tibia fx even though the leg was amputated this was still an injury

March Question of the Month

admin — Thu, 01 Mar 2012 07:00:20 +0000

Q: A baseball player was accidentally struck in the throat by a hard swung bat. He had immediate pain and difficulty speaking. In the ED a laryngotracheoscopy was performed with diagnosis of nondisplaced fracture of the larynx with vocal cord contusion and edema. Please code this injury.
A: Code 340210.4 the vocal cord involvement raises the severity level of this injury

February Question of the Month

admin — Wed, 01 Feb 2012 07:00:49 +0000

Q: Scenario: Man falls from a ladder while trimming a tree striking the upright post of a mental fence before impact on the ground. 1. Deep 18cm laceration across the abdomen with obvious evisceration of bowel. Exploratory Lap report only describes a 2. serosal tear at the junction of the duodenum and jejunum with a small hematoma. How would you code these injuries?
A: Cannot code evisceration, code the abdomianl laceration as minor laceraton < 20 cm 510602.1, code serosal tear assign to jejunum as partial thickness injry 541422.2 hematoma is part of this injury, Lis Franc injury is a dislocation of tarsometatarsal joints with no mention of fracture, cartilage involvement or ligament injury so code 878030.1

January Question of the Month

admin — Sun, 01 Jan 2012 07:00:20 +0000

Q:Pedestrain struck by vehicle who expires 10 minutes after arrival in ED. No CTs taken.
Medical Examiner report: fracture dislocation at C1/C2. Cause of death blunt cervico spinal trauma.
Trauma sheets have Trauma Surgeon documentation:
1. Crepitus R femur mid shaft,
2. Obvious open fracture L femur midshaft
3. Distinct crepitus ribs R side 1-6
4. Multiple lacerations/abrasions over back and flank
5. Crepitus and abnormal alignment cervical spine appears to be dislocation with fracture
A: 1. There is nomention of spinal cord injury at all so that cannot be coded even through it is very likely. It appears the cervical injury may be the cause of expiration but there is always the possibility of internal injury not mentioned and an abbreviated examination due to the mechanism. We cannot presume there is cord injury based on the documentation present.

We must code conservatively based on what we do know.

Code 650216.2. Fracture with or without dislocation no cord involvement NFS.

Why would we not use the box directions to code specific for C1? We have no description at all as to what part of C1 is fractured or if there are multiple fractures. The same is true for C2. In the case of fracture dislocation you code once to the superior vertebrae involved.

2. Crepitus R ribs 1-6 here there is a minimal Med Examiner report that is hardly complete so we can use the AIS guidelines to code these rib fractures based on clinical observation since the patient did expire. code 450210.2 (See the boxed rule p.82)

Note: Normally you are not to code fractures without radiological evidence but in this case it was appropriate to code based on the very obvious clinical evidence of extremity fracture and expiration precluding any diagnostics. You would use a NFS code since you don’t have radiological evidence to “place” the fracture location.

3. Crepitus R femur NFS-830001.3
4. Open fracture mid shaft L femur-8532223 (you can see this location)
5. Multiple lacerations/abrasions over back and flank: Two ISS body regions are included here since the flank is included in the abdomen body region and AIS directions encourage coding in the correct body chapter but assigning superficial injury to the external ISS body region.

Laceration back-410600.1 we know no specifics about the lacerations so use the NFS code.

Flank-510600.1 we use the NFS code.

You may assume the abrasions and lacerations are in the very same location with the laceration as the deepest part of the injury but it would be an assumption. Since the trauma sheets state abrasions without location you can also code the abrasions in each region they occur as you did the lacerations. Abrasions thorax 410202.1 Abdomen 510202.1.

Both the lacerations and abrasions could each be coded with one external body region code as multiple injury without specific location 910200.1 and 910600.1. The ISS will be the same either way these superficial injuries are coded.

December Question of the Month

admin — Thu, 01 Dec 2011 07:00:52 +0000

Q:A child is admitted to the ED after playing on the trampoline where another child landed on him. Xrays are done and a navicular fracture is identified. Please code this injury
A:This fracture requires more information as to whether or not this is a tarsal or a carpal bone; In an actual clinical situation, the physical examination and xray would b labeled as wrist or foot; If this is a tarsal navicular fx then the appropriate code would be 857451.2; if this is a carpal navicular then code 752461.2

November Question of the Month

admin — Wed, 02 Nov 2011 17:28:06 +0000

Q: Driver of a motorcycle without a helmet is struck by a large truck on the highway. He arrives with a GCS 4 and has the usual workup with a CT-head that does not demonstrate any injury. He remains in coma for several days and undergoes an MRI which clearly identifies diffuse axonal injury (DAI) located at the corpus callosum; How would you code this injury and what is your rationale for the choice?
A: Because of the length of coma, the DAI is coded from the concussive section of the head chapter even though we know it is located at the corpus callosum. The coma is consistent for > 24 hours with the MRI appropriately done to confirm the diagnosis and reason for prolonged coma. Code: 161011.5

October Question of the Month

admin — Sat, 01 Oct 2011 07:00:16 +0000

Q: A trauma activation is called for a patient with a GSW to the lower abdomen. Immediate laparotomy is undertaken and a perforation to the sigmoid colon identified. The sigmoid is resected, colostomy placed, and the patient moves to the ICU. Please code this abdominal injury

A: The sigmoid is part of the colon and therefore coded to the “colon” in the abdomen chapter. A perforation is identified. The injury should not be coded any more severely just because the sigmoid was resected. Code: 540824.3

September Question of the Month

admin — Thu, 01 Sep 2011 07:00:41 +0000

Q: The patients arrives after a MVC in which their chest and neck were pinned between the seat and the steering wheel for a period of time; After all the scans are complete, a diagnosis of asphyxia from loss of airway while trapped is given. At 24 hours, she is awake and alert with no neurologic deficits. How would you code this injury? To what ISS body region is this severity assigned?
A: Asphyxia, although a sequelae of injury, is codeable when it is the direct result of the trauma. The code is found in the external and other trauma chapter of the dictionary. Code: 020002.3 and assign to the head body region for ISS.

August Question of the Month

admin — Mon, 01 Aug 2011 07:00:04 +0000

Q: A patient is admitted after an assault with a baseball bat to the head; among his injuries, a tympanic membrane rupture; How do you code this injury?
A: a tympanic membrane rupture is coded as 240216.1; note that frequently this injury is also associated with a basilar skull fracture so look for that on the CT scan or a clinical diagnosis of such.