Part B Insider (Multispecialty) Coding Alert

ICD-10:

Sprain and Strain Diagnoses Flourish Under ICD-10

Published on Tue Jan 19, 2016

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You’ll now find over a dozen codes just for neck pain.

You cannot afford to take it easy on coding for sprains and strains, as they form a major group of secondary diagnosis codes that help demonstrate medical necessity.

“PI and WC billing requires you using theses codes,” explains Elizabeth Earhart, CPC, with Godshall Chiropractic in Millersville, PA. “Some payers are allowing ICD-10 coding. It is also important to know the differences between the two in terms of value as well as paying attention to the initial, subsequent codes.”

Not so long ago, sprains and strains were combined within a single blanket code in ICD-9. However, times have changed, and now in ICD-10, providers have manifold options for these.

“Having more codes allows for specificity and leaves little room for error; however, having this many codes can be overwhelming,” opines Earhart. “There are so many options to choose from and sometimes you do not have the full story. Questioning the doctor for greater details can work but some doctors want to get through patients quickly without writing every little detail down because he didn’t have to before.”

Because it’s so vital to your practice, we bring you this new series of spinal strain and sprain codes to ease your coding blues. Read on to gain expertise on the neck injury codes, to begin with.

Compare the Anatomy of the Injury Codes: Then and Now

Background: Injury codes in ICD-9-CM were grouped by injury type, but in ICD-10 they are grouped by anatomic location. If you observe the organization of the blocks in Chapter 19 (Injury, poisoning and certain other consequences of external causes [S00-T88]), you would note that the second character identifies the anatomic location. For most of these blocks, the character after the decimal is the one that designates the type of injury. The “3” is for sprains, while the “6” or “9” is for strains. The seventh character can have three values: A, initial encounter, D, subsequent encounter and S, sequela.

Look for all Sprains and Strains Here:

Chapter 19. Injury, poisoning and certain other consequences of external causes (S00-T88)

S00-S09 Injuries to the head
S10-S19 Injuries to the neck
S20-S29 Injuries to the thorax
S30-S39 Injuries to the abdomen, lower back, lumbar spine, pelvis and external genitals
S40-S49 Injuries to the shoulder and upper arm
S50-S59 Injuries to the elbow and forearm
S60-S69 Injuries to the wrist, hand and fingers
S70-S79 Injuries to the hip and thigh
S80-S89 Injuries to the knee and lower leg
S90-S99 Injuries to the ankle and foot

“I recently attended a round table discussion for coders and these codes seem to be the most confusing,” admits Earhart.

Get Started On Searching for the Code First

Suppose you need to search for neck sprain. Remember that the documentation should clearly mention sprain of the ligaments of the cervical spine in order to assign the correct code. Now, look for SPRAIN under dislocation/ligament/joint. Then follow the sequence:

Locate letter S (Injury, poisoning and certain other consequences of external causes)
Go to S1 (Injuries to the neck)
Identify S13 (Dislocation and sprain of joints and ligaments at neck level)
Pick out S13.4 (Sprain of ligaments of cervical spine)
Reach S13.4xxA (Sprain of ligaments of cervical spine, initial encounter)
And stop!

Since this code does not have a fifth or sixth character, we are instructed to drop in a couple of “x” placeholders. Also, do not confuse the “A” (Initial encounter) for the initial visit. The initial encounter should be used during the entire time the patient is receiving active treatment for the condition.

Explore the Possibilities: A Dozen-Plus Codes for Neck Sprain and Strain

Next, delve deeper into neck sprains and strains in ICD-10. In ICD-9, you reported neck sprain and strain with a common code: 847.0 (Neck sprain) under category 847 (Sprains and strains of other and unspecified parts of back). Let us explore the ICD-10 category range S10-S19 (Injuries to the neck) and see what we have here.

Neck sprain: You will now code for neck sprain using category S13 (Dislocation and sprain of joints and ligaments at neck level). This code includes:

Avulsion of joint or ligament at neck level
Laceration of cartilage, joint or ligament at neck level
Sprain of cartilage, joint or ligament at neck level
Traumatic subluxation of joint or ligament at neck level
Traumatic tear of joint or ligament at neck level.

You’ll also have codes further on for the cervical spine, other and unspecified parts of the neck regions such as:

S13.4XXA/D/S: (Sprain of ligaments cervical spine, initial encounter/ subsequent encounter, sequela)
S13.8XXA/D/S: (Sprain of joints and ligaments of other parts of neck, initial encounter/ subsequent encounter, sequela)
S13.9XXA/D/S: (Sprain of joints and ligaments of unspecified parts of neck, initial encounter/ subsequent encounter, sequela).

Each of the above codes can have a seventh character as A, D, or S, denoting the initial encounter, subsequent encounter, and encounter for the sequela.

Neck strain: For neck strain we have options in the category S16 (Injury of muscle, fascia and tendon at neck level). You have three codes here too that represent the initial encounter, subsequent encounter and encounter for the sequela. The base code is S16.1XXA/D/S: (Strain of muscle, fascia and tendon at neck level, initial encounter/subsequent encounter/sequela).

Tame the Whiplash Injury Codes

Let us solve a case now. A patient presents to your practice with a whiplash injury of the cervical spine. Now consider your options under ICD-10. Your best bet will be S13.4xx_ (Sprain of ligaments of cervical spine).

Here’s why: You could get confused if you are only looking at the brief descriptors, as you would not find the specific diagnosis. However, if you go deeper into the long descriptor of S13.4xx_, it also comprises:

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

Lesson: Do not underestimate the value of official long descriptors, includes notes and category notes. They might just be holding the clue you are searching for.

Here’s more: In case you would like to know, thyroid region sprain (ICD-9-CM code 848.2), now is coded as S13.5xx_, (Sprain of thyroid region).

Final takeaway: Let the Tabular List always be your guide when trying to decide which codes are most accurate.

“Know your guidelines,” decrees Earhart. “Know your LCDs. Know your insurers and what they will pay. This will make it so much easier for you to pick the correct code. You can also use your support staff to help get the details. The CA or front desk person may know which side or locality, or can even tell you when the injury happened and how many times that person has been in related to that injury if you do not have the full story.”