Good morning, everybody. My name is Tina Shepard, and I'm here to introduce you to our speaker for this month's PCAA webinar. It's exciting that we have over, like, 200 participants, and I can see why. I'm happy to introduce you to Robin Schrader. She's the Trauma Registry Operations Manager for Virginia Commonwealth University Medical Center in Richmond, Virginia. She also works as a trauma registrar part-time with AMN for Staten Island University Hospital in New York. Robin is also the chair of the American Trauma Society CFTR Prep Committee and the Association of Virginia State Trauma Registrars Educator. Robin's background includes over 30 years in the healthcare industry and 13 of those years being spent in the trauma registry. So, Robin, thank you so much for presenting for PCAA today, and we're excited to see your lecture on coding extremity injuries. Thank you, Tina. Good afternoon or good morning, wherever you may be, and I'm happy to be here and present some coding for upper extremity injuries. So let's get started. Our objectives today are to recall the anatomy of the upper extremity and to describe the coding principles of upper extremity injuries. So we'll start off with the anatomy of the upper extremity. So the function of our bones are to move the hands around the body during your activities of daily living. The shoulder girdle provides a wide range of motion, as everyone knows. You can swing your arm around in that and roll it around. And it's divided into a couple of different structures, which would be the shoulder, the upper arm, the elbow, your forearm, your wrist, and then the hand. Starting up at the shoulder, you have your scapula, which is your shoulder blade. It's that triangular flat bone that's on your back there that you can kind of try to push together. And it is that flat bone and has an attachment for 17 different muscles. So it articulates with the humerus at the glenohumeral joint and clavicle at the acromioclavicular joint. The glenohumeral joint has the glenoid fossa, and that's where your arm attaches. And the acromion articulates with the clavicle, and the coracoid process helps to stabilize that shoulder joint. You can see here where all of that kind of forms together. So your clavicle, it's that slender bone that has an S shape, and it is susceptible to fracture due to its size. So whether it's a MVC or a fall, you'll find it in children when they fall sometimes and obviously in auto accidents. It's divided into thirds. So you have the lateral acromial, it articulates with the scapula. And so about 15% of fractures occur here. And you can see that up above on the diagram where your ends are. The middle shaft, about 80% of fractures occur there. And then the medial or sternal end articulates with the manubrium, and that's the sternoclavicular joint there. And about 5% of fractures occur here. So you see most of them occur in the shaft or that lateral or acromial end, so the shoulder end of the bone. The bones of the humerus, the large bone is the humerus. This is the long bone of the upper limb, and it extends from the shoulder to the elbow. And so you have three different parts of the humeral. You have the proximal end, the shaft, and the distal end. And you'll see there, the proximal end includes the head, the anatomical neck, the surgical neck, and the greater and lesser tuberosities. And then the shaft there is the site of attachment for various muscles and is that main portion of the bone. And then the distal, which is the medial and lateral supracondyles, the trochlea, and the capitulum. And you see on this diagram, I think this is a pretty good diagram for you for reference of all those different areas. And then it shows you all those fossas for attachments. The radius is the long bone in the forearm. It articulates in four places. So the elbow joint is the articulation between the head of the radius and the capitulum of the humerus. And you can see that on the diagrams. The proximal radial ulnar joint, articulation between the radial head and the radial notch of the ulna. And then your wrist joint, which is the articulation between the distal end of the radius with the carpal bones. And then your distal radial ulnar joint is the articulation between the ulnar notch and the head of the ulna. So you have a lot of different articulations there, four of them. And your proximal radius is the head, neck, and radial tuberosity. You have the shaft and then the distal radius, which is that siloid process all the way at the bottom. The ulna is also the long bone in the forearm. It's the smaller of the two. It acts as a stabilizing bone. Proximal is the olecranon or the elbow, the coronoid process, the trochlear notch, the radial notch, and the tuberosity of the ulna. So all of those are in the proximal portion of the ulna. And you have your shaft and then the distal part, which is the ulnar siloid process. So the hand. So the hand has three types of bones. It has carpal bones, they are proximal, and there are a set of eight. And they are those irregularly shaped bones. And then your metacarpal bones. And there's five, each related to a digit. And the same with your phalanges, which are the distal part. And those are the bones of the fingers. And each finger has three, except for the thumb, which only has two. And you can see that on your diagram there, along with your interphalangeal joints and your metacarpophalangeal joint. Then your carpal bones provide the support and flexibility to soft tissue there. And you see, again, they're all colored in there. Each bone has a different color, and you can then see the difference between all of those tiny little irregularly shaped bones. You have the scaphoid, the lunate, the triquetrum, the pisiform, the trapezium, the trapezoid, the capitate, and the hamate. And then your metacarpal bones, specifically, are numbered one through five, starting with the thumb being number one. And so you have metacarpal one being the thumb, then your index, middle, ring, and little finger. And they consist of a base, a shaft, and a head. So again, even more parts. So you have a hand that's this tiny little thing. And I know everyone thinks, well, no matter what they do, you get such a low ISS. And there are so many, there could be so many injuries to that hand. The phalanges, again, are the bones of the fingers. The thumb has a proximal and a distal phalanx. And the other digits all have the proximal, middle, and distal phalanges. So again, it shows you your carpals in green, metacarpals in blue, the phalanges in that tan color, and you see that there are three in all digits except two in the thumb. Getting into the larger bones, the humerus, and this is the proximal humerus. So your types of fractures with the humerus, there are several. In the proximal area, you have the one-part fracture. And that fracture can involve one to four parts, but none of those parts are displaced. They account for approximately 70, 80% of proximal humeral fractures and are almost always treated non-surgically. A two-part fracture is when the proximal humeral bone is broken in two places. One segment is displaced, which is either the greater or lesser tuberosity or the humeral head. So you have two of those areas fractured, and one of them is displaced. They account for about 20% of proximal humeral fractures. And then your three-part fracture is when the proximal humeral bone is broken, obviously, in three places. One tuberosity fracture is displaced. The surgical neck fracture is displaced, and then there's another fracture besides that. And these account for about 5% of proximal humeral fractures. And then lastly is the big one, which is the four-part fracture, which is the proximal humerus is broken in four places. The articular surface is no longer attached to any part of the humerus. So where you see the articulation, it's not attached anymore. So it's a complete articular fracture. These account for less than 1% of the proximal humeral fractures and almost always or pretty much always require operative management to help fix them. So again, that four-part is a complete articular. It's no longer attached. When you get into your humeral shaft fractures, and humeral shaft fracture risk factors include osteoporosis and age or having had previous fractures. Humeral fractures can also be pathologic. You'll sometimes see that. In the shaft, you have the green stick fracture. And a green stick fracture, it's a partial thickness break where only the cortex and periosteum are interrupted on one side of the bone. So the bone kind of bends and cracks, but it doesn't break into two pieces. So if you can see on that x-ray, you see on one side it's broken, but it doesn't go all the way through. And then you have your transverse or perpendicular, and you'll see on the side all the different types of humeral shaft fractures. So you have transverse or perpendicular is usually from direct blow. You're oblique, curved, or at an angle. You have that spiral fracture, which usually results from some kind of rotational force to that bone. The comminuted, which break or splinter into more than two fragments. And segmental, when there's at least two fracture lines. Then your lower end of the humerus or distal humerus, you have simple supracondylar fractures, which is no intercondylar fracture, most common in children with that fall on outstretched hands. And supracondylar, just so everyone can put that at nose, it's a fracture that would be just above the elbow. And it is very common in children. You see supracondylar fractures all the time. They can occur from sports. They can occur from a fall, from a height, especially monkey bars, things like that, or from that fall on an outstretched hand. And then you have your comminuted supracondylar, which again, that has no intercondylar fracture. And then your lateral epicondyle, you can have an avulsion fracture, or you can have an actual regular fracture. But those avulsions are very rare in adults and are most commonly found in children. And you see that medial epicondyle fracture, an avulsion fracture of the medial epicondyle is the third most common fracture in children. So those of you that work in pediatric centers probably see a lot of supracondylar fractures in children all the time. And then that lateral condyle is the second most common. So again, lateral and medial, second and third. The medial condyle regular fracture, that is rare in children. And that transcondylar fracture is extra articular. Single transverse fracture line, usually located at the level of the condyle or below. And you see on that diagram, your lateral condyle, your medial condyle, that Y and T for that transcondylar fracture, which goes straight across there. And then you have your pificeal fractures. And so the pificeus is the growth plate of the bone. And then the metificus is the neck portion of the bone. So pificeal fractures occur in those areas. Walter Harris is on the upper or lower end of that pificeal. So type one, a force hits the growth plate, separating the rounded edge of bone from the bone shaft. And you'll hear this sometimes as a slipped pificeus. That's the term that you'll hear often. Type two is a fracture that passes along most of the growth plate and up through the metificus. And then that type three is an intra-articular fracture through the pificeus to the pificeus, where it takes a horizontal orientation extending to the edge of the pificeus. You see that there. And then your type four is an intra-articular where the fracture extends through the pificeus. And type five is due to crush or compression injury to the growth plate. And you see there, it's just the growth plate that is affected. And again, that type five is pretty uncommon. Forearm fractures. So your forearm fractures, that's the upper end of the ulna. And again, the olecranon process is that bony process that sticks out. It's actually the end of the ulna, but remember that is, you know, when you bend your arm, you're what we call our elbow. So a torus fracture is a buckle fracture, and a lot of times that's from that fallen out stretched hands. You can have an olecranon process without intraarticular extension, with intraarticular extension, or you can have a fracture of the coronoid process of the ulna. When you get into the shaft, and you'll see there, I wanted to mention on that diagram, the olecranon there, you see how that elbow is fractured right off there. And then the shaft of the ulna, you again can have that green stick fracture, and that is where that bone bends and cracks on one side. And then again, the same types of fractures, transverse, oblique, spiral, comminuted, or segmental, when there's at least two fracture lines together. And again, remembering that when you're coding these fractures, that those are important words to look up, or if you're using some type of tricoder, or coding a 3M coder, that you should make sure that you are including all of these descriptive words, because they're very important. And then your Montego's fracture of the ulnar shaft is a proximal third of the ulna, and it has dislocation of the radial head. They're very rare in adults, and mostly found in children. More forearm fractures. And so the upper end of the radius is your proximal radius. And again, you have that torus or buckle fracture, where the outer layer of bone twists, compress, or bend under that impact or pressure. And again, those are most commonly found in children. And they are a stable fracture, meaning that the broken pieces of bone are all still in place. And then you have the head of the radius, so radial head fractures. And they're categorized by degree of displacement and intra-articular involvement. And here, I use the Mason classification. So you see there, type one, type two, type three, type four. Type one is non-displaced or minimally displaced. Type two is partial articular with displacement and some angulation. And then type three there, you see, is a comminuted fracture, as you see all those little pieces, and displacement. And that is complete articular. And then your radial head fracture with an associated elbow dislocation is type four. Forearm fractures, your radial shaft. Again, you have that green stick that bone bends and cracks. Transverse fracture, the line perpendicular to the shaft. Oblique, the break is curved or out at an angle. Spiral, the complete fracture or torsion due to rotation or twisting. That comminuted bone broken in more than two places. Segmental fracture has at least two distinct fracture lines. So there's your difference between comminuted and segmental, is that comminuted, the bone is broken in more than two places, where segmental, the fracture has at least two distinct fracture lines. And glazes is a distal third radial shaft fracture with associated distal radial ulnar joint injury. And you see that in that X-ray there. And then getting into the lower end of the radius or the distal radius and your wrist fractures. So again, you'll find several different types. A torus fracture, common in children with that fall on outstretched hand. One side of the bone bends, but does not actually break through the bone. A collies fracture, which you see there on that upper image on the right-hand side with the pink. And a collies is a complete fracture of the radius close to the wrist. It's extra articular and it has a dorsal angulation. Then the Smith's fracture on the other hand there, you see in the yellow, that is the distal radius. Displaced or angulated in the direction of the palm of the hand. So the volar angulation, and that one is partial articular. So collies is extra articular, Smith's is partial articular. And then the Barton's. And Barton's is an intraarticular fracture. It's a compression injury with marginal shearing fracture many times on that fall on outstretched hands. It is a complete articular fracture. So again, making note of that a collies is extraarticular, a Smith's is partial articular, and a Barton's is complete articular. And I always say make notes in your AIS book where you need to so that you know that you're going to the right place to code a fracture. Barton's again is that intraarticular from that fallen outstretched hands. And there is dorsal dislocation of the dorsal rim of the radius and the palmer or volar angulation. There's a reverse Barton's fracture, which is intraarticular fracture with volar displacement. So you still can have a reverse Barton's, which is obviously the opposite. Then getting in again to these types of fractures. I know everyone has questions about, is something partial articular, complete articular? I know there's always questions about those fractures. So this is a great reference here, types of fractures. And these are looking at the distal end segment there, extraarticular, radial styloid avulsion, simple fracture, and then a wedge or multi-fragmentary. And then you get into partial articular, sagittal, a Barton's, a reverse Barton's, and then your complete articular, simple articular, multi-fragmentary with metifacial. And then that multi-fragmentary articular, simple or multi-fragmentary metifacial. Periprosthetic fracture. So I have seen this question go round and round and round and round. Periprosthetic fractures, some institutes collect them, some exclude them completely, some keep certain ones. So I think your facilities should decide what they choose to keep in your registry. But a periprosthetic fracture with a non-traumatic mechanism, obviously should be excluded. Periprosthetic fractures due to underlying osteoporosis, osteopenia, or a pathologic fracture should be excluded. An M97 code should be excluded from trauma registry. If that's the only code you have, then that right there is an exclusion. However, periprosthetic fractures with a traumatic mechanism should be coded to the traumatic fracture area and included. And you can use your primary code for coding to that traumatic fracture. And then you can actually throw in that M code as a secondary code for the periprosthetic. Look for documentation that the fracture is traumatic in nature and not pathologic or a hardware issue that somebody is having issues, they have loose hardware, whatever the fact is. If you do not have enough definitive documentation, then I would query that orthopedic surgeon to find out if that fracture was caused by, for instance, the fall versus some other reason for that patient. So again, I do think that this is something that is definitely facility defined more often than not. But I would say if there is true trauma involved, then you definitely should include it in your registry. Other injuries, so crush injuries, and here you see a pretty massive crush injury. And again, in order to code, say a hand injury or an arm injury to crush, so you may have the description of the mechanism of injury as a crush, but in order to use the crush code, you have to have a massive destruction of skeletal, vascular, nervous, and tissue systems. So all of those systems have to be involved. So you have to have obviously fractures, vascular, so vessels have to be involved and damaged, nerves, nerves have to be damaged, and obviously the tissue, which you see in this example, that all of those things are affected. And so you would be able to use that crush code for this. De-gloving injuries are avulsion injuries in which an extensive portion of the skin and subcutaneous tissue are completely separated from the underlying fascia and deeper structures. And so you'll get that description of a de-gloving, that they had a de-gloving, and you'll find that the skin is not on their hand anymore. Muscles, tendons, and ligaments. So you have tears, avulsions, contusions, strains. You can have partial or complete disruption, partial equaling partial thickness and complete equaling full thickness. So when you're looking at coding injuries of those that you are coding, to the best ability that you can, partial or complete. And when you get into usually the tendon and ligament injuries, usually you have an MRI or something that tells you whether they're full thickness or partial thickness injuries. In joint injuries, you have sprains, which are stretching or tearing of ligaments. And the ligaments are the tough bands of fibrous tissue that connect two bones together in a joint. Subluxation of a joint is a partial dislocation of that joint. And a dislocation is a separation of the two bones where they meet at a joint. So you can have either or. Vessels, again, you can have all different types of injuries to vessels. You can have that intimal tear, which is a tear in the endothelium. And this little diagram here, I refer to often if I'm looking at description in an op note or in a physician's note. And then you can have lacerations, perforation, or punctures. And again, minor or superficial or incomplete. And then you have major, which is a rupture or transection. And there you see what a laceration versus a transection. There you have an incomplete transection. Contusions and segmental spasm. A contusions and a thrombosis. Contusion and a true aneurysm versus, you get those pseudoaneurysms and external compression. And then there's a listing here for you of the main vessels in the arm, in the upper extremity. Nerves. So lots of nerves as well throughout the upper extremity. And nerves can have a couple of different kinds of injuries. Contusions. So a nerve palsy, which is a lack of, a lack or partial lack of function. Or a neuropraxia, which is the mildest form of traumatic peripheral nerve injury. And it results in weakness of the nerve. So it can be a weakness or a paresthesia. And then lacerations is when that nerve is actually cut. Can sometimes be surgically repaired, but there should be some type of motor loss. So getting into some coding guidelines before we get into procedures. If a fracture is not specified as displaced or non-displaced, per ICD-10 coding guidelines, it would be coded to displaced. Dislocations or subluxations get coded separately. Thumb and non-thumb fingers are also separate injury categories. And a complex fracture is three or more fragments with proximal and distal fragments not touching. And bilateral proximal amputations are assigned only one code. So if somebody was unfortunate to have both of their hands amputated in an accident, they're assigned one code. Procedures. So starting off with your ORIF, your MIN, your XFIX, intramedullary nail and an external fixator. So you can use a reposition code and there's your upper bone or upper joint. And then again, you have your open percutaneous, percutaneous, endoscopic, or external, which is closed. And your internal fixation device, external fixation device, internal fixation device, intramedullary. Your XFIX can be monoplanar, ring, hybrid, or no device. And so throwing in here some of those examples of those external fixation devices. And so you have monoplanar where it has at least two pins in each main fracture fragment connected with one single rod. You kind of see that one in the middle, actually there on the leg. Sometimes a second rod can be added. And then the ring is the one all the way on the left there on the bottom of that leg. And it use rings connected to the bone through wires and pins. And that hybrid bridges from the epiphysis to the dipyphysis to stabilize the metadipyphysial region. And you see that is kind of like a, kind of looks like it has like a triangular look to it. And the intramedullary devices are in the marrow space of a bone. That's where those are inserted. Again, remember, if you have a open fracture, you should be sure that you are, you know, coding the procedure of that first operative washout. And you can have that extirpation of a bone, which is when you're cleaning out the fracture site. So there could be bone chips, dirt, whatever's in there. Some of the skin and subcutaneous tissue could be, you know, anything. And then you have an excision. And so the excision is when they're actually removing part of that bone. So not just bone chips that are like laying in that open fracture, but cutting or scraping off of that bone that's there. You should always code to the deepest layer only. So if they are actually doing an excision of the bone along with cleaning everything else out, that's what you would code as that excision of bone. Detachment or amputation. So that's another question that comes up with that mid, low and high. So again, mid meaning the middle portion of the shaft, low, the distal shaft and below, and high, the proximal shaft and above. And again, refer to your anatomical regions, upper extremities for the detachment qualifier descriptors. Again, coding only to the deepest level. So an example, an open fracture, irrigation and debridement clean out of skin, dirt, debris, muscle. You would code the excision of the muscle. And again, open fracture, IND clean out of all of the above and use a roger on the bone. Then you would code to the excision of the bone. Nerve procedures. You would use the peripheral nervous system, to zero one, and then you have a release or a repair or any other. Obviously those are the two most commonly used. And then vascular upper extremities and veins. You could have a bypass, a repair, a restriction, an occlusion, and there are the beginnings of your artery and vein codes in ICD-10. There are a few common questions that come across and those are articular, you know, is it an articular fracture? Is it intra-articular? Is it extra-articular? Is it complete? Is it partial? Many times everyone's asking those questions. Articular is forming a joint. So intra-articular, the fracture line extends into the joint. Extra-articular, the fracture line does not involve any part of the joint. Complete articular, the joint surface is fractured at the entire joint. Sorry, and the entire joint is separated from the dipephysis. And then partial, the joint is involved but stays attached to the dipephysis. So again, I say to everybody, I hope that the registrars are able to see the x-rays of these fractures. And so sometimes, you know, if the wording or if there's an op note or maybe there's not an op note, they're taking care of it non-operatively and you don't have enough that you feel to code it accurately, look at the fracture lines on the x-ray. And if you're not sure, ask one of your program staff to help you, one of the nurses or your program manager, somebody, you know, more clinical that maybe can help you to figure out if it's intra-articular or extra-articular, et cetera. Terminology, another question that comes up, which is that ICD-10 versus AIS. So, you know, in ICD-10, you have those collies and Smith's fractures. Barton's fracture is listed in AIS, but, you know, many of the fractures, they're not listed maybe in the same exact terminology as they are in the ICD-10. So I always say, make notes in that AIS book of collies is extra-articular, Smith's is partial-articular, Barton's is complete articular. And then always make sure that you're coding to the most precise code using terms provided, comminuted, transverse, oblique. And again, if you're using, you know, encoders of any type, whether that be in your registry software or you're using an ICD-10 type encoder of 3M, you know, making sure that you're trained on it properly and that even though you're using that to pull your code, that you're looking at those codes and you're making sure that they're correct because you can literally throw in one tiny word and it will throw your entire code off. So making sure that you're rereading, they make sense, they look right. I am an old school, like to use the book coder, but again, if you're using those, making sure that you're double-checking them. Okay, so you guys all were sent out questions prior to today and we had a pretty good turnout with sending back in these questions on the quiz. So we're gonna go over what everybody thought. So a patient sustains an open comminuted fracture of the left humeral shaft with posterior dislocation of the humeral head. Injuries to code would be an open comminuted humeral shaft fracture, an open comminuted humeral shaft fracture with dislocation, open comminuted humeral shaft fracture and a posterior dislocation of the humeral head, a closed posterior dislocation of the humeral head or none of the above. And 80%, which is great, came up with the correct answer, which is an open comminuted humeral shaft fracture and posterior dislocation of the humeral head should both be coded. Fractures and dislocations are coded as separate injuries. Number two, a comminuted fracture of the proximal humeral shaft should be coded to proximal humerus, humeral shaft, distal humerus or none of the above. Well, again, the humeral shaft can be described as the proximal shaft, the mid shaft and the distal shaft. So remember when you're reading to make sure you're reading all of those words because the humeral shaft has a proximal and distal end as well as a mid shaft. So a comminuted fracture of the proximal humeral shaft would be coded to the shaft. So just remember to look at all those words, not just that descriptor, that proximal or distal descriptor. A Barton's fracture is intraarticular, extraarticular, partialarticular or none of the above. And again, we just went over a Barton's fracture is an intraarticular fracture. If a fracture is not specified displaced or nondisplaced, you should always code to displaced, nondisplaced, not further specified or unsure or really don't know. So fractures per ICD-10 coding guidelines, if it is not specified as nondisplaced or displaced, you always code to displaced, okay? When there's a laceration over the fracture, I need to code the laceration. So you see there true or false and the answer is false. So an open fracture by definition means the skin overlying the fracture is lacerated and communicates with the fracture. The external laceration is implicit in the code for the open fracture and is not coded separately. So again, that's from the AIS Update 2008 coursebook on page 43. And if you have an open fracture, you would not also code that laceration. Okay. When there's an abrasion or contusion over the fracture site I need to code it. This is true. And again, that seems like there was a lot of maybe confusion and maybe thinking about the fact that, you know, a laceration would not be coded, but abrasions and contusions associated with fracture areas should be coded also. Okay. And we now have some time for questions. Okay, Robin, thank you so much. That was great. And I do have to say there's comments about great anatomy pictures and people are interested in being able to have this PowerPoint. So it is available for download if you check your email from yesterday. And so you can keep these PowerPoints and the anatomy pictures, which were amazing. We do have a lot of great questions. So I'm going to try to get through some of them. Is there a difference between oblique and angulated? Is there a difference between oblique and angulated? So I myself would probably use that pretty interchangeably. So this is a good one, but the periprosthetic fractures, how do you differentiate which came first when there's like a non-traumatic injury? So fracture first versus fall first. No, wait, you're asking about a non-traumatic injury? Yes, so it'll state, if you have a non-traumatic injury, yes, so it'll state without a traumatic mechanism, I guess. So how would that, how would you be able to differentiate that? Well, if they, if somebody documents that it is a non-traumatic fracture, it wouldn't go in our registry. I'm not sure that I'm answering that question. Right, okay, there's a fall. So if there's a fall, no other known trauma mechanisms, then how would you be able to tell whether the fracture came first or the fall came first? That's a great question. And again, that's where I would be querying my orthopedic surgeon to say, hey, do you think this is caused by trauma or do you think it was caused by something else if it's not documented anywhere? Yeah. Okay, and then also the statement about bilateral amputation, having one code. There's not really. Yeah, I think I stated that a little off the, I think it's if there's, if it's proximal, if there's, you would only code one. If there's two and there's one proximal to it, you would code one. That's what the, what I was saying, sorry. I said that wrong. Okay, and so, yeah, they were asking about multiple fingers and multiple toes. Would you still only code one? No, I would definitely would code, those are separate. Yeah, I would code all of them. Yeah, it's if they're proximal to each other. Okay. Yep, yep, I said that wrong. I have. No problem. With nerves, would you code repair or reattachment? Well, now it would depend what they're doing. So if you are at a facility where they're, where they are doing actual, you know, reattachment, I would read what that op is telling you and I would go by that, whether they're repairing something or they're actually reattaching. So, you know, look at your, I mean, I would look at just, I have to bring up my book just to look at, I like to look at what the terms, you know, what they're using for each term, what the definition of that term is. And then that's what I would go by what exactly they're doing. Obviously a reattachment is more than a repair, you know, a lot more than a repair. It does ask if it was completely detached. Then I, if it was, if it was completely detached, if it was completely detached, then I probably would do a reattachment. Again, I would follow what the op, you know, when I'm reading the op itself, but that sounds like a reattachment. Okay. And then how do you code a low pressure VersaJet? Extrication in the OR? That one I have to get back to you on. I am not sure. A low pressure VersaJet. What did she say? A low pressure VersaJet? Mm-hmm, and that's with a question mark, and then extrication with a question mark in the OR. Okay, I will look into that and I will get back with TCAA and then they'll get, they'll send it out. But I will look that, I will check that out. Not sure. And let's see, this one is when it says it's mildly displaced or minimally displaced, would you use non-displaced? It depends on where it's at. So like facial fractures, mildly displaced doesn't count for displaced in that, in the face. I know the facial bones. So it really, it does depend. I would go by the rules in the AIS book and the ICD-10 book for that. But I think you can still code for an arm or a leg, the mildly displaced as displaced. I'm pretty sure it's facial bones. Actually, I am sure it's facial bones that need to be significantly displaced to code displacement. Okay. And then they're also asking about Collie's fracture is coded to partial articular per the AIS book. This seems incorrect. We do have an answer here. For radius systole, Collie's is coded to partial articular. So what is the difference between partial articular versus intraarticular? In AIS, I think of partial as intraarticular. And someone did help us out and say that the VersaJet comes up as an extrication in the 3M encoder. Oh, got it. Your Collie's can be both. It could be intra or extraarticular. So I see in the book, it says partial articular. But there are extraarticular fractures of the Collie's. So you know what? What I'm going to do is I'm gonna talk to our ortho and ask, and I will give a complete clarification on that. There's a lot of great feedback on here. Excellent presentation. Thank you so much. And you answered a lot of people's questions and clarified a lot of confusion. So it was definitely a great presentation. Okay, thanks. Yes, I think this was a wonderful presentation. And everyone's making those comments here as well. So Robin, thank you so much. Sure, no problem. Thank you. And we'll be able to get the clarification that you get to CCAA out to everyone that registered. Yep. And yeah, so we appreciate your time and we appreciate everyone joining. So I hope everyone has a great day. Thank you again, Robin, so much. Sure, thank you.

coding upper extremity injuries

anatomy of upper extremity

fractures

proximal humeral fractures

distal humeral fractures

radial head fractures

distal radius fractures

nerve injuries

coding guidelines