Pain Management Coding Alert

Published on Wed Apr 01, 2015 PDF

Extended 7-digit codes will bring even more specificity.

Millions of people suffer neck and back injuries due to whiplash each year, making it a fairly common condition for pain management specialists to treat. The current ICD-9 structure offers multiple diagnosis options, and ICD-10 will introduce even more in October. Start by pinpointing the affected area of the spine, and you’ll be on your way to pain-free reporting.

Check the Basics for ICD-10 Choices

Most whiplash injuries affect the cervical spine, but ICD-9 includes codes for injuries to other spinal areas. You find these in category 847 (Sprains and strains of other and unspecified parts of back), with six options for various parts of the back: 

• 847.0 – … neck 
  
• 847.1 – … thoracic 
  
• 847.2 – … lumbar 
  
• 847.3 – … sacrum 
  
• 847.4 – … coccyx 
  
• 847.9 – … unspecified site of back. 
  

Whiplash injury falls under 847.0. 

Take note: If a patient experiences sprain or strain of the lumbosacral area, you report 846.0 (Sprains and strains of sacroiliac region; lumbosacral [joint] [ligament] sprain). 

ICD-10 cross-over: Your best group for whiplash coding under ICD-10 will be S13.4xx_ (Sprain of ligaments of cervical spine) under category S13 (Dislocation and sprain of joints and ligaments at neck level). It could be easy to get confused if you only look at the brief descriptors, as you would not find the specific diagnosis. However, if you go deeper into the description of S13.4xx_, you’ll find that the code also includes:

• Sprain of anterior longitudinal ligament cervical
• Sprain of atlanto-axial (joints)
• Sprain of atlanto-occipital (joints)
• Whiplash injury of cervical spine.

Remember: Always read the long descriptor before assigning the code.

Seventh character note: For codes denoting injury, keep in mind that you should add the appropriate seventh character to the ICD-10 code such as:

A: Initial encounter
D: Subsequent encounter
S: Sequela.

“The seventh character will prove helpful in that we will be indicating to the payers the type of encounter,” explains Doreen Boivin, CPC, CCA, a coder in Saco, Maine. “Even though the CPT® code denotes the new patient and established patient exams, the diagnosis will allow more specificity on each encounter.”  

“The seventh character provides more specificity in regard to the diagnosis,” adds Marvel J. Hammer, RN, CPC, CCS-P, PCS, ACS-PM, CHCO, of MJH Consulting in Denver, Co.  “The patient could be an established patient with a new diagnosis of whiplash and the ‘A’seventh character would be reported.” 

The following is from the ICD-10-CM Guidelines: “While the patient may be seen by a new or different provider over the course of treatment for an injury, assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time. …7th character “A”, initial encounter is used while the patient is receiving active treatment for the condition. Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and continuing treatment by the same or a different physician.”

Don’t Forget Cervicalgia

When a patient has neck pain, you know that’s a symptom rather than a diagnosis. In ICD-9, the correct code is 723.1 (Cervicalgia) which excludes conditions due to intervertebral disc disorders (722.0-722.9) and spondylosis (721.0-721.9). 

You’ll also have a code for cervicalgia in ICD-10, listed under the category M54 (Dorsalgia). The best match is M54.2 (Cervicalgia), excluding cervicalgia due to intervertebral cervical disc disorder (M50.--) and current injury of the spine by body region.