AAAM AIS Questions

September Question of the Month

admin — Wed, 01 Sep 2010 21:57:59 +0000

Q: A patient arrives after an MVC in which the car rolled several times. CT head - negative for injury, skull normal; CT cervical spine - occipital condyle fracture, normal alignment; neurologic examination is normal- able to move all extremities, GCS= 15; there is no drainage from the ears or nose, no ecchymosis

August Question of the Month

admin — Sat, 31 Jul 2010 19:19:42 +0000

Q: A burn patient arrives in the ED after being involved in a house fire where she was removed from the bedroom engulfed in smoke and unresponsive. The initial evaluation included intubation, a carbon monoxide level and ABG showing pO2 60 mmHg. In addition, a bronchoscopy was done to assess the airways. The results were positive carbonaceous deposits requiring lavage to clear the airway and erythema with friable membranes.

A: 419206.5; The mechanism of injury implies inhalation burn from breathing the superheated air along with the smoke. Inflammation of the airways, friability with obstruction of the bronchi requiring clearance is evidence of severe inhalation injury; ABG demonstrates hypoxemia as well

July Question of the Month

admin — Thu, 01 Jul 2010 07:09:26 +0000

Q: Your newest trauma patient has suffered a basilar skull fracture. While reading the CT scan of the head, you notice that there is also a dislocation of the ossicles on othe left. After coding the basilar skull fracture correctly, you are left with a decision about the ossicular dislocation. How do you code this specific injury?

A: 240212.1; the ossicles are seen on CT scan but they are the skeletal component of of the ear. Thus, the AIS code for the ossicles is found in the face, under the organ “ear”. This injury is frequently associated with a basilar skull fracture, which would be coded separately. The patient is likely also demonstrating issues with hearing on the left where the ossicles are dislocated.

June Question of the Month

admin — Tue, 01 Jun 2010 12:07:44 +0000

Q: CT scan abdomen/pelvis - no visceral injury identified; bony pelvis without evidence of injury; lumbar spine- L2 vertebral body superior endplate compression fracture age-indeterminate

May Question of the Month

admin — Sat, 01 May 2010 07:11:21 +0000

Q: CT scan abdomen/pelvis - spleen normal; kidneys and adrenal glands normal; liver laceration gr IV injury - multiple deep lacerations. The patient is taken to OR where the operative note states liver laceration gr V injury. What would you code?
A: 541828.5; The surgeon is visually observing the liver and thus the operative grading is more accurate than the CT scan. An autopsy would also over-ride the reading of the CT if the grade is different.

April Question of the Month

admin — Thu, 01 Apr 2010 07:00:35 +0000

Q: Motocross collision, wearing helmet; multiple soft tissue injuries; no other injury identified.
A: 910000.1; Since the skin injuries are not clearly defined, the external “soft tissue injury NFS” code is the best choice; even if the site of injury was known, this is the best code since the type of soft tissue injury is not provided.

March Question of the Month

admin — Mon, 01 Mar 2010 07:00:25 +0000

Q: Patient arrives after a 20′ fall from a height landing on his right leg; examination shows a visibly shortened RLE; plain film of the pelvis demonstrates that the right iliac wing is higher than the left with apparent SI joint dislocation and fractures of the superior and inferior pubic rami on the right; CT scan confirms a Malgaigne shear fracture of the pelvis; blood loss is not known.

:A: 856171.4; A Malgaigne fracture is a vertical shear fracture with instability and complete separation of one side of the pelvis from the other (disruption of the pelvic ring). If blood loss had been provided, more definition could have been used. However, in this case NFS was the best choice.

February Question of the Month

admin — Mon, 01 Feb 2010 07:35:10 +0000

Q: CT scan face - fracture of the lamina papyracea.

A: 251231.2; The lamina papyracea is the medial wall of the orbit.

January Question of the Month

admin — Fri, 01 Jan 2010 07:00:03 +0000

Q: A patient arrives to the ED with a severe head injury; he is transported to the ICU in anticipation of organ donation and while the brain death evaluation is completed. His final diagnoses include the expected head injury and brain death. What do you do when coding this chart regarding the brain death itself?

A: Brain death is a situation not an injury. The coder would appropriately code the lesions identified on CT as well as any edema. However, brain death is a sequelae of those injuries. Even if the patient had no codeable injuries in the brain, there would still be no code to apply for the brain death. The only option in that situation would be to evaluate the chart for a traumatic anoxic event.

December Question of the Month

admin — Tue, 01 Dec 2009 07:00:36 +0000

Q: A 4 y o child is accidentally burned when his pajamas catch fire from a candle. His burns are described as 15 % first, 10 % second and 9 % third degree. What is the correct way to code this injury?

A: The revised burn rule states that in cases described this way, the first degree burns should be coded separately from the second and third. Therefore, the first degree burns are coded as 912002.1. The second and third degree burns together total 19 % so they are coded together as 912014.3. (Remember that this child is less than 5 years old.)