Md. Code Regs. 30.08.05.24

Current through Register Vol. 51, No. 24, December 2, 2024

Section 30.08.05.24 - Injury Severity Criteria

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.

Md. Code Regs. 30.08.05.24

Regulation .24 amended and recodified from .21 effective 45:9 Md. R. 463, eff. 7/1/2018