Coding ICD-10 for cervical strains and sprains

Avoid issues that can cost you money and compliance visits when coding ICD-10 for cervical strains and sprains

Coding mistakes can cost you. That’s why it’s so important to know ICD-10 for cervical strains and how it applies to chiropractic and the ailments you see frequently in the office. Armed with this knowledge, you can reduce your compliance risks and hopefully avoid issues with billing and revenue.

In ICD-9, strains and sprains had a single code — but it’s different for ICD-10. Now, these each have their own codes to simplify the coding process. Once you know the strain and sprain codes, you can use extensions to provide more information about the purpose of the patient encounter and what you accomplished during the visit.

Find out more about how to handle ICD-10 coding for these two common ailments.

Strains vs. sprains

Each of these two has a separate code. Extensions are used to modify the code and indicate something else about the visit. For instance, “A” shows the visit was, generally speaking, the first patient encounter.

Here is the basic format:

• S13.4XXA: Cervical spine sprain at the first encounter
• S13.4XXD: Cervical spine sprain, later encounters
• S13.4XXS: Cervical spine sprain, for sequelae encounters
• S16.1XXA: Cervical spine strain, for the first encounter
• S16.1XXD: Cervical spine strain, for subsequent encounters
• S16.1XXS: Cervical spine strain, for sequelae

Now it gets a bit more complicated. Each extension is generally used to show when the appointment happened, but in practice it isn’t that simple. Sadly, many chiropractors make mistakes by adding the wrong extension at the wrong time.

Using extensions

It’s easy to get these extensions wrong, so be sure to look closely at their true meaning and purpose. “First encounter” really means active treatment — this often occurs at the first visit, but a future visit could also be classified as active treatment for the patient’s condition. In other words, there could be situations where you’d use an “A” extension on a subsequent visit.

Extension usage:

• A: “Initial encounter,” or active treatment of your patient
• D: “Subsequent encounter,” or the next visit after active treatment is completed. This is when the chiropractor verifies that treatment was successful and the patient is improving
• S: “Sequelae,” or a visit for complications related to the original problem

As you use these extensions, it’s possible that most of the time “A” will really be only used for the first visit and “D” will be for later visits. That said, it’s important that you follow the true purposes of these extensions carefully. Hopefully, using these extensions correctly will ensure you have fewer coding issues when addressing such issues as ICD-10 for cervical strains.

Avoiding coding errors

Coding errors can cost a fortune. Don’t let this happen to you. To reduce your own coding errors, consider implementing these best practices:

• Accuracy review: Try reviewing your coding once again before sending it off.
• Checklist: Using a checklist, double-check your coding work for accuracy.
• Training: Get the right coding training for whoever does your coding work. If that’s someone you hire, consider sending them to a class or purchasing training materials. If it’s you, work closely with your software vendor to learn any coding software you’re using and invest in your own training so you can accurately code.
• Clearinghouse: You can also partner with a clearinghouse to review your claims before they’re sent. This is another opportunity to reduce coding errors and promote accuracy in your billing.

At least every quarter, review your coding process and note any mistakes that are repeatedly showing up. Any error should be investigated, if possible, to find any commonalities and contributing factors you can fix.

Become a coding master

Once you can master coding principles such as these, you’ll likely find you’re able to become more productive. Great coding practices save you time and help you stay on top of your revenue and compliance.

Sources:

Painter, F and Prideaux, D. “Diagnosis Codes (ICD-10) Commonly Used in the Chiropractic Office.” Chirowebs. Accessed: June 2019. Retrieved from: https://chiro.org/LINKS/DX_ICD_10.shtml.