Patients who present to the emergency department (ED) complaining of neck pain after a motor vehicle accident, a ground level fall, or other traumatic type of injury can often be diagnosed with a neck sprain or strain. Neck Sprain/Strain, ICD-9 Code 847.0, is one of the top 25 diagnosis codes worked up in the ED and coded by McKesson ED coders.
According to the Merck Manual, accident victims, who may have a spinal cord injury, especially in the cervical region, must be handled with great care to protect the cord from further damage. Until the extent of damage is known, all spinal injuries should be treated as unstable.”1 Neck sprain/strain is also known or referred to as whiplash. Whiplash is defined as “An imprecise term for an injury to the cervical vertebrae and adjacent soft tissues. It is produced by a sudden jerking or relative backward or forward acceleration of the head with respect to the vertebral column. This type of injury could occur in a vehicle that was suddenly struck from behind.”2
Ligaments, which attach bone to bone, can be torn or sprained, and muscles can be torn resulting in strain. Sprains and strains can be mild, moderate, or severe. Ligaments, muscles, and tendons may be completely or partially torn. If a tendon (attaches muscle to bone) is completely torn (ruptured), the affected body area cannot move. The extent of the injury depends on the strength of the force of the mechanism. For example, if a patient falls while walking, that can cause a minor injury as opposed to a fall from a two-story building rooftop which will cause severe injury.
With that in mind, I have reviewed some charts of the elderly and some ground level falls have also caused some very serious injury. The most obvious symptom of a musculoskeletal injury is pain - the injured part hurts. Other symptoms could, and typically do, include swelling, bruising or discoloration, the inability to move or use the injured part, and possible loss of feeling or numbness.
Diagnostic testing may be indicated and could include, depending on the mechanism of the injury and the presenting problems, imaging tests, such as plain film x-rays, or advanced imaging such as magnetic resonance imaging, and computed tomography (CT), other tests could include angiography (x-rays or CT scans taken after a dye is injected into arteries) to check for damaged blood vessels, and nerve conduction tests to check for damaged nerves.
Treatment could include, but is not limited to: Pain relief, PRICE (Protection, Rest, Ice, Compression, and Elevation), immobilization (usually with a sling, swathe or splint), and sometimes surgery.
There is a one-to-one crosswalk (ICD-9 to ICD-10) for Neck Sprain, not otherwise specified (NOS), but both ICD-9 and ICD-10 contain many other types of spinal sprains/strains including, but not limited to, those shown in the table below.
As mentioned above, treatment for sprains of the neck and other areas of the spine depends on the patient’s presentation, age and current history of present illness.
It is imperative that the provider document the exact findings of the examination and the diagnostic studies, if any, to determine the exact course of action for the condition presented or defined after study. This will also allow the coding staff to select the most appropriate ICD-9 or ICD-10 diagnosis code for reporting on the claim for reimbursement. Remember that the ICD-10 coding may require a 7-digit classification that addresses the category of the injury/problem for the first 3 digits, the second set of three digits addresses; 1) etiology, 2) site, and 3) the severity, and the last digit addresses the encounter for the sprain: A – Initial encounter, D – Subsequent encounter, and S – Sequela. Most ED visit services are the initial encounter and should end with as “A” as the 7th digit. If there are any characters that are not within the code/tabular index a placeholder is required. A placeholder “X” is used as a filler character if no other number or alpha character is required.
- ICD-10-CM, 2014 Complete Draft Code Set, Chapter 19, Pages 817 and 835, Injury, Poisoning and Certain Other Consequences of External Causes (S00 – T88), AAPC, Optuminsight 2013
- ICD-9-CM, 2014, Sixth Edition, 9th Revision, Clinical Modification, Chapter 17, Page 312, Injury and Poisoning (codes 800 - 999), Optuminsight August 2013.