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Making the Grade: Translating AAST Organ Injury Scale Score into ICD

May 23, 2012:

Brigid T. Caffrey, BS, CCS, Clinical/Technical Editor

Documentation of traumatic internal injuries may include the Organ Injury Scale grading score developed by the American Association for the Surgery of Trauma (AAST) in 1989 with revisions in 1994. The scores, which range from grade I to grade V or VI, make up a scaling system that describes injuries and measures their severity. Computed tomography (CT) scanning is essential for the clinical evaluation necessary for accurate scoring.

Both ICD-9-CM and ICD-10-CM provide indexing for (internal) injuries documented “(with) laceration” as minor, moderate, major (stellate), and “(with) contusion (hematoma).” The alphabetic index and tabular list do not translate these descriptors into their equivalent AAST grade classifications, although they do provide definitions in the tabular list at the subcategory levels, in ICD-9-CM with a fifth-digit subclassification or in the ICD-10-CM subcategory for certain anatomical sites. These definitions are less specific than the AAST definitions but provide a comparison between an AAST grade in relation to the ICD code assignment. The AAST website www.aast.org provides tables for each organ and the corresponding trauma injury score grade along with the equivalent ICD-9-CM code, by AAST determination.

It is helpful to compare these tables with ICD descriptions and coding instructions. For example, the AAST tables list “hematoma,” whereas ICD-9-CM states “hematoma and contusion” in the tabular list and ICD-10-CM states only “contusion.” Because AAST grades do not distinguish between open or closed, the tables provide the ICD-9-CM code for both. In ICD-9-CM, the coder must distinguish between an open and a closed injury, and in ICD-10-CM, the coder follows the instructional note to “code also any associated open wound.” In both ICD-9-CM and ICD-10-CM, an identified blood vessel injury is coded separately (ICD-9-CM Official Coding Guideline section I.C.17.a.2 and ICD-10-CM Official Coding Guideline section I.C.19.b.2).

Some terms appear frequently in the tables and codes. The capsule noted in some of the definitions is the collagenous, fibrous membrane that surrounds and protects the organ and its vasculature, such as in the spleen or the Glisson’s capsule of the liver, hepatic artery, portal vein, and bile ducts within the liver. Couinard’s segments of the liver include each segment’s independent vascular and biliary branches. The parenchyma is the functional part of the organ, such as the lobules of the liver or the red and white pulp of the spleen. The prefix juxta- means next to or near; for example, juxtahepatic venous injuries. The term “stellate” indicates that the laceration is irregular. Note that the AAST score is advanced one grade for multiple injuries or with other specifications particular to the organ according the information on the AAST website. When a CT or radiology exam notes “contrast blush,” it may indicate extravasation and possible blood vessel (arterial) injury, especially when the blush goes beyond the borders of the organ and contrast does not wash away with the bloodstream on delayed imaging. If further work-up is performed to rule out blood vessel injury, then, depending on the findings, the case would be coded according to the definitive injury (blood vessel if identified as such) or as a sign/symptom that required evaluation (Findings, abnormal). The physician should be queried if work-up results are not clear.

As always, documentation must support code assignment. Query the physician for clarification when information is unclear or incomplete to assign the most accurate code that represents the patient’s condition.


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