CAISS – AIS FAQS coding Flashcards
Q: How is an aneurysm coded? - correct answer A: An aneurysm is a sac formed by the dilatation of the
walls of an artery or a vein and filled with blood; Code as an intimal tear
Q: How is a pseudoaneurysm coded: - correct answer A: A pseudoaneurysm is a hematoma formed by a
leaking hole in an artery. Code as a vessel laceration
Q: How do I decided between coding Open vs. External approaches for procedures on open wounds -
correct answer A: External approach is for procedures performed directly on the skin or mucous
membrane and procedures performed indirectly by the application of external force through the skin or
mucous membrane. Examples of external approach procedures are closed fracture reduction, laceration
repair of skin or mucous membranes, and excisional debridement of skin only. Repair L lower arm
subcutaneous tissue and fascia, OPEN approach
Q: A patient is found down in an apartment fire without cardiac activity and was resuscitated and
transported. She had a bronchoscopy and found to have a mild inhalation injury with elevated carbon
monoxide levels. How would you code this injury and why? - correct answer A: This would be coded as
an inhalation injury. The asphyxia codes do not apply to inhalation injury. Carbon monoxide poisoning is
not a codeable injury and asphyxia applies to mechanical constriction or restriction of the airway. You
may only code the inhalation injury.
Q: When you start coding with ICD-10, there are many questions that arise. You need to make a decision
on how specific you want to be with your code selection? There are many thoughts on coding in trauma
systems and you may ask should you code everything as specific as possible? Or, can you code less
specifically and perhaps have a more efficient work process for your registrars? - Do very specific codes
have an impact on our ISS? In other words, if I code super specific, will my ISS's be higher? - correct
answer A: In regard to theses question, we recommend coding as specifically as possible using the AIS
Dictionary, and not relying on the computer to identify the codes since they don't always match and may
give you inaccurate AIS conversions and therefore inaccurate ISS.
Q: How are GSWs resulting in bony fractures or with the missile "lodged in" the bone are coded? -
correct answer A: Gunshot wounds resulting in bony fractures or with the missile "lodged in" the bone
are coded as open fractures.
Q: CT scan abdomen/pelvis shows: - 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
,CAISS – AIS FAQS coding Flashcards
laceration gr V injury. What would you code? - correct answer 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.
Q: Scenario: Man falls from a ladder while trimming a tree striking the upright post of a metal fence
before impact on the ground. 1. Deep 18cm laceration across the abdomen with obvious evisceration of
bowel. Exploratory Lap report only describes a Serosal tear at the junction of the duodenum and
jejunum with a small hematoma. How would you code these injuries? - correct answer A: You cannot
code evisceration, code the abdominal laceration as minor laceration < 20 cm 510602.1, code serosal
tear assigning it to the jejunum as partial thickness injury 541422.2 hematoma is already part of this
injury.
Q: Elderly patient fell out of bed, landing on his right side and c/o RUQ pain; CT of the abdomen
demonstrates an injury to the ligamentum teres hepatis. What would you do with this injury? - correct
answer A: The ligament teres hepatis represents the remnant of the fetal left umbilical vein. As such, it is
not a codeable injury.
Q: How do you code a renal artery psuedoaneurysm? - correct answer A: A pseudoaneurysm, also
termed a false aneurysm, is a leakage of arterial blood from an artery into the surrounding tissue with a
persistent communication between the originating artery and the resultant adjacent cavity. A
pseudoaneurysm is a hematoma formed by a leaking hole in an artery. Code as a vessel laceration.
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. - correct answer A: This should be coded as
510602.1. This is a "skin" code (assigned to the External ISS body region) and includes skin,
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.
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. - correct answer
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
, CAISS – AIS FAQS coding Flashcards
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? - correct answer
Q: A patient sustains a duodenal laceration involving > 75% of D3 (the transverse portion). How is this
injury coded in AIS 2005? - correct answer A: The correct code is 541023.3. The coder should note that
the portion of the duodenum that is involved will affect the severity code. D2 (the descending portion)
carries a higher severity when it is involved.
Q: According to Organ Injury Scaling (OIS) guidelines in many cases you may advance one grade for
multiple lacerations of an organ. ("Advance one grade for multiple injuries to same organ up to Grade
III." AAST) How should multiple Grade II liver lacerations be coded in AIS? - correct answer A: Although
the Organ Injury Scale allows one to assign a higher grade for multiple lacerations to an organ, the AIS
does not allow that for our coding. Multiple Grade II liver lacerations should be coded as 541822.2.
Q: How is Hemoperitoneum coded? - correct answer A: Hemoperitoneum is not codeable in AIS
Q: What are the Intraperitoneal organs - correct answer A: Intraperitoneal organs are completely
wrapped by visceral peritoneum. These organs are the liver, spleen, stomach, superior part of the
duodenum, jejunum, ileum, transverse colon, sigmoid colon and superior part of the rectum.
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 - correct answer 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
Q: A young lady arrives to the ED. She was on her way home from school and as usual climbed over a
fence as a short cut. However today suffered a straddle injury while going over the fence. She has
evidence of a large contusion of the vulva. There are no lacerations and there is no vaginal injury. -
correct answer A: 545610.1; although the injury appears to be a skin contusion, the vulva is part of the
abdomen and is coded there. It is also coded to the abdomen for the ISS.
Q: How would you code an intertrochanteric femur FX w/ subtrochanteric extension? - correct answer A:
I remember Kathy Cookman saying that if there's a fracture "extension", then you would code to the
main fracture, which in this case is the IT FX.
Q: How is an aneurysm coded? - correct answer A: An aneurysm is a sac formed by the dilatation of the
walls of an artery or a vein and filled with blood; Code as an intimal tear
Q: How is a pseudoaneurysm coded: - correct answer A: A pseudoaneurysm is a hematoma formed by a
leaking hole in an artery. Code as a vessel laceration
Q: How do I decided between coding Open vs. External approaches for procedures on open wounds -
correct answer A: External approach is for procedures performed directly on the skin or mucous
membrane and procedures performed indirectly by the application of external force through the skin or
mucous membrane. Examples of external approach procedures are closed fracture reduction, laceration
repair of skin or mucous membranes, and excisional debridement of skin only. Repair L lower arm
subcutaneous tissue and fascia, OPEN approach
Q: A patient is found down in an apartment fire without cardiac activity and was resuscitated and
transported. She had a bronchoscopy and found to have a mild inhalation injury with elevated carbon
monoxide levels. How would you code this injury and why? - correct answer A: This would be coded as
an inhalation injury. The asphyxia codes do not apply to inhalation injury. Carbon monoxide poisoning is
not a codeable injury and asphyxia applies to mechanical constriction or restriction of the airway. You
may only code the inhalation injury.
Q: When you start coding with ICD-10, there are many questions that arise. You need to make a decision
on how specific you want to be with your code selection? There are many thoughts on coding in trauma
systems and you may ask should you code everything as specific as possible? Or, can you code less
specifically and perhaps have a more efficient work process for your registrars? - Do very specific codes
have an impact on our ISS? In other words, if I code super specific, will my ISS's be higher? - correct
answer A: In regard to theses question, we recommend coding as specifically as possible using the AIS
Dictionary, and not relying on the computer to identify the codes since they don't always match and may
give you inaccurate AIS conversions and therefore inaccurate ISS.
Q: How are GSWs resulting in bony fractures or with the missile "lodged in" the bone are coded? -
correct answer A: Gunshot wounds resulting in bony fractures or with the missile "lodged in" the bone
are coded as open fractures.
Q: CT scan abdomen/pelvis shows: - 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
,CAISS – AIS FAQS coding Flashcards
laceration gr V injury. What would you code? - correct answer 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.
Q: Scenario: Man falls from a ladder while trimming a tree striking the upright post of a metal fence
before impact on the ground. 1. Deep 18cm laceration across the abdomen with obvious evisceration of
bowel. Exploratory Lap report only describes a Serosal tear at the junction of the duodenum and
jejunum with a small hematoma. How would you code these injuries? - correct answer A: You cannot
code evisceration, code the abdominal laceration as minor laceration < 20 cm 510602.1, code serosal
tear assigning it to the jejunum as partial thickness injury 541422.2 hematoma is already part of this
injury.
Q: Elderly patient fell out of bed, landing on his right side and c/o RUQ pain; CT of the abdomen
demonstrates an injury to the ligamentum teres hepatis. What would you do with this injury? - correct
answer A: The ligament teres hepatis represents the remnant of the fetal left umbilical vein. As such, it is
not a codeable injury.
Q: How do you code a renal artery psuedoaneurysm? - correct answer A: A pseudoaneurysm, also
termed a false aneurysm, is a leakage of arterial blood from an artery into the surrounding tissue with a
persistent communication between the originating artery and the resultant adjacent cavity. A
pseudoaneurysm is a hematoma formed by a leaking hole in an artery. Code as a vessel laceration.
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. - correct answer A: This should be coded as
510602.1. This is a "skin" code (assigned to the External ISS body region) and includes skin,
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.
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. - correct answer
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
, CAISS – AIS FAQS coding Flashcards
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? - correct answer
Q: A patient sustains a duodenal laceration involving > 75% of D3 (the transverse portion). How is this
injury coded in AIS 2005? - correct answer A: The correct code is 541023.3. The coder should note that
the portion of the duodenum that is involved will affect the severity code. D2 (the descending portion)
carries a higher severity when it is involved.
Q: According to Organ Injury Scaling (OIS) guidelines in many cases you may advance one grade for
multiple lacerations of an organ. ("Advance one grade for multiple injuries to same organ up to Grade
III." AAST) How should multiple Grade II liver lacerations be coded in AIS? - correct answer A: Although
the Organ Injury Scale allows one to assign a higher grade for multiple lacerations to an organ, the AIS
does not allow that for our coding. Multiple Grade II liver lacerations should be coded as 541822.2.
Q: How is Hemoperitoneum coded? - correct answer A: Hemoperitoneum is not codeable in AIS
Q: What are the Intraperitoneal organs - correct answer A: Intraperitoneal organs are completely
wrapped by visceral peritoneum. These organs are the liver, spleen, stomach, superior part of the
duodenum, jejunum, ileum, transverse colon, sigmoid colon and superior part of the rectum.
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 - correct answer 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
Q: A young lady arrives to the ED. She was on her way home from school and as usual climbed over a
fence as a short cut. However today suffered a straddle injury while going over the fence. She has
evidence of a large contusion of the vulva. There are no lacerations and there is no vaginal injury. -
correct answer A: 545610.1; although the injury appears to be a skin contusion, the vulva is part of the
abdomen and is coded there. It is also coded to the abdomen for the ISS.
Q: How would you code an intertrochanteric femur FX w/ subtrochanteric extension? - correct answer A:
I remember Kathy Cookman saying that if there's a fracture "extension", then you would code to the
main fracture, which in this case is the IT FX.
