Regulation .24 Injury Severity Criteria.
Regulation .24 Injury Severity Criteria.LinkCopy Citation
For the purposes of Regulation .20D(2)—(3) of this chapter, a patient with severe injury shall have:
A.
An injury severity score (ISS) greater than or equal to 13;
B.
A penetrating injury with systolic blood pressure of less than or equal to 90 millimeters of mercury;
C.
A thoracic injury classified as one or more of the following International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) codes:
(1)
861.21 — Lung contusion, without open wound to thorax;
(2)
861.31 — Lung contusion, with open wound into thorax; or
(3)
807.4 — Flail chest;
D.
A blunt injury to the abdomen with major solid visceral injury classified as one or more of the following ICD-9-CM codes:
(1)
864.03 — Moderate laceration injury to liver without mention of open wound into cavity;
(2)
864.04 — Major laceration injury to liver without mention of open wound into cavity;
(3)
864.13 — Moderate laceration injury to liver with open wound into cavity;
(4)
864.14 — Major laceration of liver with open wound into cavity;
(5)
865.03 — Injury to spleen with laceration extending into parenchyma without mention of open wound into cavity;
(6)
865.04 — Injury to spleen with massive parenchymal disruption without mention of open wound into cavity;
(7)
865.13 — Injury to spleen with laceration extending into parenchyma and open wound into cavity;
(8)
865.14 — Injury to spleen with massive parenchymal disruption and open wound into cavity;
(9)
866.01 — Hematoma of kidney without rupture of capsule or mention of open wound into cavity;
(10)
866.02 — Laceration of kidney without mention of open wound into cavity;
(11)
866.11 — Hematoma of kidney without rupture of capsule but with open wound into cavity; or
(12)
866.12 — Laceration of kidney with open wound into cavity;
E.
A major surgical procedure in the cranial, thoracic, vascular, abdominal, or spinal body regions, classified as one or more of the following ICD-9-CM procedure codes:
(1)
Cranial:
(a)
01.2X — Craniotomy and craniectomy;
(b)
01.3X — Incision of brain and cerebral meninges;
(c)
01.52 — Hemispherectomy;
(d)
01.53 — Lobectomy of brain;
(e)
02.0X — Cranioplasty;
(f)
02.1X — Repair of cerebral meninges;
(g)
02.3 — Extracranial ventricular shunt;
(h)
02.92 — Repair of brain; or
(i)
02.94 — Insertion of replacement of skull tongs or halo traction device;
(2)
Thoracic:
(a)
34.02 — Exploratory thoracotomy;
(b)
34.82 — Suture of laceration of diaphragm;
(c)
34.84 — Other repair of diaphragm;
(d)
37.1X — Cardiotomy and pericardiotomy; or
(e)
37.91 — Open chest cardiac massage;
(3)
Vascular:
(a)
38.3 — Resection of vessel with anastomosis (use 4th digits 2, 3, 4, 5, 6, 7, 8, 9);
(b)
38.4 — Resection of vessel with replacement (use 4th digits 2, 3, 4, 5, 6, 7, 8, 9);
(c)
38.8 — Other surgical occlusion of vessels (use 4th digits 2, 3, 4, 5, 6, 7, 8, 9);
(d)
39.3 — Suture of vessel;
(e)
39.56 <MD >Repair of blood vessel with tissue patch graft;
(f)
39.57 — Repair of blood vessel with synthetic patch graft;
(g)
39.58 — Other repair of vessel;
(h)
39.6X — Extracorporeal circulation and procedures auxiliary to heart surgery; or
(i)
39.98 — Control of hemorrhage, not otherwise specified;
(4)
Abdominal:
(a)
41.43 — Partial splenectomy;
(b)
41.5 — Total splenectomy;
(c)
41.95 — Repair and plastic operations on spleen;
(d)
42.82 — Suture of laceration of esophagus;
(e)
42.89 — Other repair of esophagus;
(f)
44.61 — Suture of laceration of stomach;
(g)
44.69 — Other repair of stomach, not otherwise specified;
(h)
45.0X — Enterotomy;
(i)
45.5X — Isolation of intestinal segment;
(j)
45.6X — Other excision of small intestine;
(k)
45.7X — Partial excision of large intestine;
(l)
45.8 — Total intra-abdominal colectomy;
(m)
46.0 through 46.03 — Other operations on intestine;
(n)
46.7X — Other repair of intestine;
(o)
50.0 — Hepatotomy;
(p)
50.22 — Partial hepatectomy;
(q)
50.3 — Lobectomy of liver;
(r)
50.4 — Total hepatectomy;
(s)
50.6X — Repair of liver;
(t)
52.5X — Partial pancreatectomy;
(u)
52.6 — Total pancreatectomy;
(v)
52.95 — Other repair of the pancreas;
(w)
54.11 — Exploratory laparotomy;
(x)
55.4 — Partial nephrectomy;
(y)
55.5X — Complete nephrectomy;
(z)
55.8X — Other repair of kidney;
(aa)
56.8X — Repair of ureter; or
(bb)
57.8X — Other repair of urinary bladder; or
(5)
Spinal:
(a)
03.53 — Repair of vertebral fracture;
(b)
81.00 — Spinal fusion, not otherwise specified;
(c)
81.01 — Atlas-axis spinal fusion;
(d)
81.02 — Other cervical fusion, anterior technique;
(e)
81.03 — Other cervical fusion, posterior technique;
(f)
81.04 — Dorsal and dorsolumbar fusion anterior technique;
(g)
81.05 — Dorsal and dorsolumbar fusion, posterior technique; or
(h)
81.06 — Lumbar and lumbosacral fusion, anterior technique;
F.
A major pelvic fracture, classified as one or more of the following ICD-9-CM codes:
(1)
808.43 — Multiple, closed, pelvic fractures with disruption of pelvic circle; or
(2)
808.53 — Multiple, open, pelvic fractures with disruption of pelvic circle; or
G.
Two or more long bone lower extremity fractures that can be either ipsilateral or contralateral, classified as one or more of the following ICD-9-CM codes:
(1)
820.XX — Fractures of neck of femur;
(2)
821.XX — Fractures of other and unspecified parts of femur; or
(3)
823.X2 — Fractures of fibula with tibia.