CAISS 2022 Spine

What are the different parts of the vertebra that can be fractured?

Body, laminae, spinous and transverse processes, facets, pedicles, and odontoid of C2

What is the atlas?

C1

How do you code a dislocation of lumbar spine?

Code as one injury and assign it to the superior vertebra.

How do you code a pars interarticularis injury ( Hint, to what part of the vertebra)

Code to the pedicle. Pars interarticularis lays between pedicle and lamina and used to be coded to the lamina

How do you code an injury described as a cauda equina laceration?

Coded as a cauda equina contusion

Quadriplegia or paraplegia with no sensation is what?

Complete cord syndrome

If it is not clear whether the cord was contused or lacerated, how should you code the injury?

Contusion

How do you code diagnosis of cord compression, or epidural or subdural hemorrhage within the spinal cord documented by imaging or autopsy?

Cord contusion

What is a definition of spinal cord injury?

Damage to neural elements in the spinal CANAL (spinal cord and caudal equina)

True or false - Each vertebra fracture is coded as a separate injury if there is no associated spinal cord injury.

False

Name two types of disc injury

Herniation and rupture

If there is preservation of some sensation or motor function, how do you code the injury to the cord?

Incomplete

Anterior cord, central cord, lateral cord are what type of cord syndrome?

Incomplete cord syndrome

Brown-Sequard is an example of what type of cord syndrome?

Incomplete cord syndrome

When do you code paralysis?

It is coded according to its status at 24 hours post injury. If the patient dies within the first 24 hours, code the status of documented paralysis at the time of death

How do you code whiplash?

It is synonymous with cervical strain

How should you code incomplete quadriplegia or incomplete paraplegia?

It should be coded as an incomplete cord injury.

How do you code SCIWORA?

It should be coded as spinal cord contusion not further specified. It is most commonly attributed to the cervical region.

What are the definitions of minor compression and major compression fractures?

Minor compression is less than or equal to 20% loss of anterior height. Major compression is greater than 20% loss of anterior height

For the thoracic and lumbar spine what is an exception when coding multiple fractures of the same vertebra?

A major compression fracture is coded additionally.

What is the odontoid?

A toothlike projection of C2 on which C1 pivots

Name two exceptions to using 650217.2 - multiple fractures of the same for vertebrae

Odontoid or major compression fractures are coded additionally.

If a cord injury is continuous which level is coded?

Only the highest. If the cord is injured in more than one area, and the injuries are separate and distinct, then all the injuries are coded

What is another term for tetraplegia?

Quadriplegia

What is another name for the odontoid?

The dens

What does level of injury refer to?

The most caudal (aka inferior; lower; towards the tail) segment of the cord with normal motor and sensory function

What is another term for the atlanto-axial?

The odontoid

How do you code co-existing injuries to the spinal cord and the vertebral column?

They are coded as a single entry and only have one AIS code.

Where do you code a lateral mass fracture?

To the pedicle

Name some codable immediate sequela associated with spine injuries.

Transient neurological signs a.k.a. paresthesia, incomplete cord/cauda equina syndrome (hemiplegia), complete cord/cauda equina syndrome and radiculopathy.

True or False: Cord contusions and Cord lacerations include sections for incomplete and complete cord syndrome?

True

True or false-- an AIS code for vertebral dislocation is only assigned when there's no fracture or cord involvement.

True

True or false. Can you code a stretch injury within the brachial plexus?

True

True or false. In the spine chapter, dislocation is synonymous with subluxation.

True

True or false. Plexus contusion is synonymous with stretch injury.

True

True or false: Subluxation in the spinal column is coded the same as a dislocation

True. The spinal column is unique in this.

Where do you find a brachial plexus injury in the AIS dictionary?

Under the cervical spine

Where do you find cauda equina injuries in the AIS dictionary?

Under the lumbar spine

If a vertebra sustains more than one fracture, for example transverse process and facet, how do you code it?

Use the multiple fractures of the same vertebra code. There are exceptions for the odontoid or major compression fractures which are coded additionally.

How do you code a palsy or a paresis?

Usually coded as a nerve contusion

How do you code a burst fracture?

Vertebral body

Is there a code for cervical spine injuries without further substantiation or no autopsy confirmation of specific injuries?

Yes, but it has a severity of 9

If the transient neurological symptoms resolve within 24 hrs post injury, do you code them?

Yes. Per the 2019 AIS clarification: Within the first 24 hours post injury, patients with transient signs and symptoms should be coded even if they are resolved within the 24 hour period.""

If there is a spinal cord injury such as compression, EDH or SDH within spinal cord and a fx AND no documented deficit, how do you code this?

the coder must choose to either code the cord injury OR the fracture. Current rules prohibit coding both. (2016-Clarification)

What is the spinal coding algorithm?

1. Is the cord involved 2. Is it a contusion or laceration? 3. Are neurological symptoms transient, incomplete or complete? 4. Is there a fx, dislocation or both

What does AIS define as part of the spine?

1. Spinal cord 2. Vertebrae 3. Disc 4. Brachial plexus 5. Nerve root 6. Ligaments and tendons

Name three miscellaneous type injuries found under cervical spine

1. Spinous ligament injury 2. Nerve root injury 3. Strain, acute with no fx or dislocation