Current through Register Vol. 51, No. 19, September 20, 2024
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-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.