Anesthesia Coding Alert

Coding for the diagnosis and treatment of whiplash is usually pretty straightforward, but there are situations when coders need to take special care, especially if the patient's symptoms persist despite conservative therapy and warrant more extensive and expensive treatment.

For a lot of people, the term "whiplash" might conjure images of a shady lawyer and equally suspect client trying to finagle compensation for alleged injuries. But physicians commonly diagnose patients who have been in an automobile accident with whiplash (847.0). Another term doctors use to describe a whiplash injury is cervical acceleration/deceleration insult.

Whiplash can occur when the force of an automobile collision causes the vehicle occupant's head to whip back and forth (hyperextension/hyperflexion), says Marvel J. Hammer, RN, CPC, CHCO, president of MJH Consulting, a Denver-based anesthesia and pain management coding and consulting firm.

"Whiplash describes the injury to soft tissues in the cervical spine intervertebral discs, muscles, ligaments and nerves," Hammer says. In addition to neck pain, whiplash symptoms include neck tenderness and stiffness, headache, dizziness, nausea, jaw pain, shoulder and/or arm pain, numbness or tingling, blurred vision and, in rare cases, difficulty swallowing. Some patients have cognitive, somatic or psychological conditions, such as memory loss, concentration impairment, nervousness/irritability, sleep disturbances, fatigue or depression. Hammer says that whiplash leads to long-term disability in 10 percent of people injured in auto crashes. Conservation Treatment Is the First Step When a patient presents with whiplash symptoms, the physician will provide a thorough exam and will often order neck x-rays to rule out fractures. Once the whiplash diagnosis has been made, conservative treatment may include physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants. Some patients may also benefit from wearing a soft cervical collar or by using a portable traction device. If conservative treatment fails to result in significant improvement, the physician may order additional diagnostic imaging tests, including computed tomography (CT) scan, magnetic resonance imaging (MRI), and/or bone scan.

Pain management physicians may also administer trigger point injections (TPI) to alleviate pain and tenderness in muscles, such as the trapezius, splenius capitis and levator scapulae. CPT lists two codes for TPI: CPT 20552 (Injection; single or multiple trigger point[s], one or two muscle group[s]) and 20553 (... single or multiple trigger point[s], three or more muscle groups). Hammer says that the difference between the two codes is the number of muscle groups the physician injects, not the number of injections he or she administers. Consequently, you should bill one unit for either of these codes. Because carriers define muscle groups differently, coders and billers should be aware of their carriers' policies.