Therapy Progression for Proper Whiplash Coding

Coding for whiplash diagnosis is usually a cakewalk, however don’t get too easy. Keep hunting for situations when the patient’s symptoms persist in spite of conservative therapy and demand more extensive medical care. Not paying heed to these diagnoses entails missed pay.
Watch for move from therapy to scans
When a patient presents with whiplash symptoms, your pain management specialist will carry out a thorough exam and will carry out a comprehensive exam and will often order neck x-rays to rule out fractures.
Initial steps: Your pain specialist diagnoses whiplash (847.0, Sprains and strains of other and unspecified parts of back; neck sprain), he normally will prescribe conservative treatment. Common options cover physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants. Some patients may also stand to profit from wearing a soft cervical collar or by using a conveyable traction device.
If conservative treatment fails to make an impact, your doctor might order additional diagnostic imaging lab tests.
Count trigger point injections the proper way
Your physician might also administer trigger point injections to relieve the patient’s pain and muscle pain. Report these procedures with 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]) or 20553 (.three or more muscles).
Note of caution: The difference between 2 codes will be the number of muscles your doctor injects, and never the involving trigger points or the number of injections he manages.
The descriptors clarify any time your provider documents a different muscle, you can count quantity of muscles to determine the difference between 20552 and 20553. If most the provider injects multiple trigger points within exactly the same muscle, a person count one muscle, without regard for the quantity of injections.
Watch out: Owing towards the ‘one or two muscles’ and ‘three or more muscles’ distinction between codes, you will report around one unit for either 20552 or 20553 for an encounter – not both codes. For instance, by simply pain management physician injects trigger points in a total of four separate muscles, compliant coding would be one unit of 20553.
For more pain relief, move to nerve blocks
When more conservative treating whiplash neglect to help the patient, doctor might administer nerve blocks to help diagnose a patient’s condition and/or provide therapeutic alleviation. Palm Springs Escorts include lidocaine and/or steroids such as methylprednisolone acetate (J1020) into cervical facet joints (such as C3-4 and C4-5).
Report it: Code the block at the first facet joint level with 64490 (Injection[s], diagnostic or therapeutic agent, paravertebral facet [zygapophyseal] joint [or nerves innervating that joint] with image guidance [fluoroscopy or CT], cervical or thoracic; single level). Submit blocks at additional facet joint levels on the following lines of your claim with +64491 (+ second level [List separately in accessory for code for primary procedure]) and +64492 (. third and any extra level[s] [List separately additionally to code for primary procedure]) as proper.
Guidance: Physicians go for fluoroscopic guidance to help ensure they inject the proper site. Earlier, you reported fluoroscopic guidance in accessory for the injection procedure computer code. Last year, CPT introduced codes 64490-+64492, which include fluoroscopic or CT opinions. Now you can simply code the injection.
Bilateral question: Often, providers administer facet joint injections unilaterally. Whether a doctor administers bilateral injections, remember to add modifier 50 (bilateral procedure) to the injection writes.
Be using a lookout for add-on diagnoses
Some factors (age, gender, and pre-existing conditions like arthritis) get a an influence on the severity and prognosis of whiplash injuries. As soon as the patient doesn’t respond to more conservative treatments or maybe if her symptoms get worse, your physician may re-evaluate her web site disorders.
In these instances, report the additional diagnoses along with whiplash.
Depend on nerve destruction as last recourse
If nerve blocks don’t bring the long-lasting relief, your pain specialist may consider paravertebral facet joint denervation.
Document it: Prior to taking the patient’s treatment to this level, your physician should have thorough documentation of other treatments. The patient’s chart should cover two important details:
The proper diagnostic paravertebral facet joint block or medial branch nerve block studies that identify distinct joint level
Documentation that the patient had significant + however not long-lasting — pain relief from the facet joint blocks. Some payers are beginning to need actual documentation and quantification of the patient’s fame. For instance, the payer might like details regarding the percentage of change in pain, time of pain relief, and a change in the patient’s functional status during reduced the diagnostic blocks.
If the patient meets these criteria, doctor may use paravertebral facet joint denervation to treat back or neck pain following whiplash/post-traumatic injury to relieve the pain of associated cervicogenic worry.
In these cases, CPT includes two codes for denervation:
64626 — Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level
+64627 — each additional level [list separately additionally to code for primary procedure].
Just like nerve blocks, physicians often carry the therapeutic destructive procedures as unilateral measures. If your specialist carries out a bilateral procedure, add modifier 50 and document which joint levels he treated.
Bottom line: With quite a few of whiplash injury and range of treatment methods for whiplash and related disorders, physicians and codes reason to know what payers cover and back as they do not really.
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