General Tips¶
General Tips
Chondroplasty - cartilage or bone repair
DeQuervan Syndrome/Disease, Radial Styloid Tenosynovitis
DVT (Deep Vein/Venous Thrombosis)
Elastic sleeve for the forearm
Evacuated hematoma with incision
Labrum tear/Acetabular Labral tear of hip
Multiple Distinct Fracture Same Body Part
Neck/Back Sprain/Strain Injuries, Treatments and Complications
Neurostimulator/Neurostimulation Treatment
Nurse Practitioner or Physician Assistant Visits
Pressure sore from cast/splint
Sprain/Strains (other than Neck and Back)
Turbinate reduction/Turbinectomy
V.A.C. system for wound care (Vacuum Assisted Closure)
Ace Bandage¶
An ace bandage is an elasticized bandage used to bind/wrap an injured body part, such as the wrist, ankle or other joint.
An ace bandage is commonly associated with sprain/strain type injuries, such as an ankle sprain. The system does have codes for a bandage wrap to the leg (93.54.4CL/R) and ankle (93.54.4DL/R). If any other body part is treated with an ace bandage, the adjuster can document the treatment in Case Notes. This is NOT a treatment that needs to be priced outside of the system.
Acetabular Labral tear of hip/Labrum tear¶
· Entered in the system as sprain/strain hip or thigh other specified site
· Select the appropriate degree of sprain - minor, moderate or severe
· The root code for the sprain/strain is 843.8
Anesthesia¶
Anesthesia administered for surgery and medicines given during surgery are included in the procedure. No additional entry into the system is required.
Arthroscopy¶
· This is a scope of the joint. If a repair or other procedure is done via the arthroscopy, then that treatment should be entered in addition to the arthroscopy. Arthroscopy also can be entered when the doctor uses it to look at the joint for diagnostic purposes.
Atelectasis¶
· Refers to a collapse of a lung
· It may include a lung sub-segment or the entire lung
· In the system, enter a collapsed lung using code ‘860.0.A - Chest Pneumothorax’
Selection of brace/splint/cast treatment based on the medical records¶
· There are various types of braces, splints and casts and some even have specific names based on the body part injured
· The system contains treatment codes for the basic/routine types of braces/casts/splints most frequently used in association with fractures, dislocations and sprain/strain type injuries
· If you have trouble determining the correct code to use, we recommend a review of the Medical Library text to help determine the code that most closely matches the medical records. The system treats all braces/splints/cast similarly so if there is not an exact match there is no impact to the case value
· Code as a treatment when first applied
· No code is needed for removal of cast
· If problems with cast (improper fitting) or cast is damaged and has to be replaced, code with 'Replacement of cast ' codes (97.1 root code)
CAT SCANS¶
· CAT Scans or CT Scans are entered based on the ‘main body part’.
· Example: In the system a CAT scan of the face would be entered as 'Computerized Axial Tomography of Head' which includes the face. This code is also used for 'CAT Scan of the Brain'
· If there are distinct and separate scans for the head and the face (e.g. orbit(s), maxillofacial bones) on the same date, the code can be entered multiple times to account for each CAT Scan
CAT Scan of Orbit/Sella with or without contrast¶
· Sella refers to a depression in the upper surface of the sphenoid bone where the pituitary gland rests
· The sphenoid bone helps form the floor of the cranium/skull
· In the system, use the code for CAT scan of head
Chondroplasty - cartilage or bone repair¶
· Cartilage repair ; search on 'r knee cartilage' or 'l knee cartilage' in the free form, choose the code for 'Division of joint capsule, ligament or cartilage'.
· Bone repair ; search on 'Chondroplasty', the system will return codes of 'Other repair or plastic operation on bone'
Cellulitis¶
· This is a type of infection and is considered a complication in the system
· The medical code description in the system is 'Posttraumatic/postsurgical wound infection'.
· A freeform on keyword 'cellulitis' and body part will return the codes
· Cellulitis can also be located on the Medical Model under type/category 'Wound infections' and selection of 'complication' as type
** Claviculectomy**
· A claviculectomy is an excision of the clavicle. Typically, it is a partial excision which involves the distal portion of the clavicle
· The code in the system that covers a claviculectomy is ‘Other partial ostectomscapula, clavicle’ , the root code is 77.81.A
Collapsed Lung¶
· A collapsed lung is entered in the system as a Pneumothorax
· In the system, use code ‘860.0.A Chest Pneumothorax’ for entering a collapsed lung
· If both lungs are collapsed this can be referred to as a ‘bilateral pneumothoraces’
· To enter use the 860.0.A code and enter the code twice
· The system will produce a warning message for a possible duplicate code when it is added for the second time
· Acknowledge that the code is not a duplicate
Contusion Grading¶
· Minor
o Covers a small, confined area of skin
o Slight skin discoloration may be present
· Moderate
o Covers an extensive area of skin
o Some skin discoloration may be present
· Severe
o Covers an extensive area of skin
o Skin is markedly discolored with a purple/black hue
o If the lower extremity is involved, walking aids may be utilized
Costosternal Dislocation¶
· Dislocation or separation in the area where the ribs and sternum meet
· The system has a dislocation code for sternum; however, it is specific to the sternoclavicular joint, which is where the sternum and clavicle meet
· Sternum dislocation-sternoclavicular joint is not the same as a Costosternal dislocation/separation
· If there is a diagnosis of Costosternal dislocation/separation , it can be entered in the system as a ‘848.42 Sprain/strain sternum-chondrosternal (joint)’
· If you believe that the sprain/strain does not adequately capture the nature of the injury, the injury can be priced outside the system
DeQuervain's Syndrome, DeQuervain's Disease or Radial Styloid Tenosynovitis¶
All of these terms refer to inflammation of the tendon sheaths of the thumb and can be found in the system using
· ‘727.04.L/R - Radial styloid tenosynovitis - left/right thumb’
· Freeform search on keyword "De Quervains" as an injury
Dog and Cat Bites¶
General guidelines for bite categories:
· Minor
· Little, if any, wound closure involved. Generally the wound is cleaned and bandaged and there is no underlying damage
· Moderate
· The skin is torn or lacerated, and debridement and wound closure is required. No underlying nerve, tendon or vascular damage involved
· Extensive
· If the bite caused an amputation, fracture, nerve damage, vascular/arterial damage or degloving it would be considered extensive. Surgical repair would often be necessary
· The size of the dog itself is not a factor in the system as a large dog could inflict a shallow bite with no other damage, while a smaller dog’s bite could go quite deep causing severe damage
· Scarring should be addressed in the Disfigurement Field on the Generate Injury Assessment panel
· If an infection develops from the wound, a Complication code for the infection should be entered into the system. Septic infections due to dog or cat bites can be found in the 027.2 series of codes
· The bite codes include the puncture wounds and any surrounding bruising; additional puncture, laceration or bruising codes do not need to be entered. However, if a fracture, or nerve or arterial damage is involved, these should be entered in addition to the bite
· If there are multiple bites, each bite should be entered separately
· If a finger or other body part is amputated during the bite a separate code for the amputation needs to be entered
· To locate dog bite or cat bite freeform search using keywords 'dog bite' or 'cat bite' and body part, such as neck, leg, hand
· The freeform search can be further refined by adding the type of bite, minor, moderate or extensive
· Dog or Cat bite can also be located on the Medical Model by clicking on the appropriate body part, by selecting the Injuries radio button, selecting Dog or Cat bites and then Search
DVT (Deep Vein/Venous Thrombosis)¶
· DVT is a blood clot which most often occurs in the leg; however, other areas of the body can also be affected, such as the arm.
· DVT is a complication that can occur following trauma, surgery or long periods of immobilization
· Freeform search using keyword 'vein' or 'deep vein' and select complication
· Medical Model Search by selecting complication, body part and select 'Phelbititis and Thrombophlebitis' from the list box
Echocardiogram¶
· This is a type of ultrasound that shows the heart’s movement
· It may be done to help determine the cause of unexplained chest pains, shortness of breath, or irregular heartbeats
· This is considered diagnostic
o ‘88.72 – Diagnostic ultrasound of heart’ can be used for an echocardiogram that is diagnostic. This treatment is assessed the same way as x-rays
o There are other types of echocardiograms (stress, Doppler, transesophageal and intracardiac (which uses a tiny catheter with an ultrasound sensor that is passed into the heart).
o The system only covers the diagnostic echocardiogram
Elastic sleeve for the forearm¶
In the system use ‘93.59.C6L/R – Other immobilization, pressure or attention to wounleft/right forearm’
Evacuated hematoma with incision¶
· Entered in the system utilizing the codes described as ‘other incision with drainage of a subcutaneous tissue’
· To locate the treatment, freeform search using the key words ‘incisional drainage’ plus the body part, select Treatments and Search
· The root code for the treatment is 86.04
Floaters¶
Floaters are a symptom from an eye injury, which may have been caused by a contusion or other injury. They can also be related to the natural aging process. There is no code entry for this in LNav.
Fluoroscopy¶
· Fluoroscopy is a type of x-ray that allows for visualization of internal structures. It is often used in conjunction with certain procedures such as injections or microscopic surgery
· In the system, no additional code is required when fluoroscopy is done in conjunction with other procedures
· A fluoroscopy can also be diagnostic in nature, so there may be instances where it is the only procedure performed. In this instance, Case Notes should be documented with regard to the fluoroscopy
Foley Catheter¶
· A Foley catheter is an indwelling urinary catheter that is inserted into the bladder to drain urine
· To locate the code in the system, initiate a freeform search using the keywords ‘urinary catheter’ as a Treatment
· The medical code is ‘57.9 Insertion of indwelling urinary catheter’
GP/TS administered injections¶
When a Trigger point injection or any other type of injection is given to the cervical (neck) or lumbar (back) area by a GP/TS and the claimant has been diagnosed with a cervical and/or lumbar sprain, entry of an office visit in addition to the injection is only necessary when an exam actually took place. If the injection is the only form of treatment received from the GP/TS, you do not need to enter an office visit.
Headaches as a Complication in the system¶
· Posttraumatic (result from a skull fracture or concussion as the injury)
· Persistent (due to whiplash/cervical sprain/strain injury) - make sure the headaches are persistent in nature - if only mentioned or complaints are limited then this is not considered persistent headaches
Hearing Loss¶
Hearing loss is entered in the ‘Permanency' tab on the Prognoses panel
Home PT or Home Exercises¶
· 93.39 ‘Physical Therapy’ - used when a physical therapist comes to the home to administer PT, this is the same code used if claimant treated at a formal physical therapy facility
· 93.19 ‘Exercise not elsewhere classified’ – used when claimant does exercises on their own based upon a doctor’s recommendation
Insect Bite¶
· Infected and uninfected, are supported in the system
· Using freeform search, enter ‘insect bite’ and the body part
· Select ‘Injury’ and then 'Search'
IV Treatment Codes¶
· 99.29 - Intravenous (IV) infusion of fluids, antibiotics, anticoagulants or other medication
· 99.15 - Intravenous (IV) feeding
· 99.18 - Infusion of electrolytes
· These treatment codes can be used when IV treatment is administered in conjunction with a single ER visit or as part of an inpatient hospital stay.
· The adjuster will have to select the appropriate code based on what the medical records indicate in relation to the type of IV treatment received.
· IV treatment is entered with a single medical occurrence date, which should be the date of treatment
· The system does not currently have the functionality to capture the duration of IV treatment for inpatient hospitalization
o If the IV is moved to different location(s) during the hospital stay and this causes additional pain and suffering
§ This is a judgment call on the part of the adjuster as to whether to enter the IV code for each time the IV was moved/re-inserted
o If there is a question about a single entry of the treatment not being an accurate reflection of the IV treatment during a lengthy inpatient hospitalization
§ This is a judgment call on the part of the adjuster if they feel additional pain and suffering is warranted
§ If the adjuster feels an additional amount should be paid for the pain and suffering
· Discuss with manager/supervisor about pricing outside of the system
· Document in Case Notes
Iontophoresis¶
· Iontophoresis is a non-invasive, painless treatment which uses electrical current to deliver drugs, such as dexamethasone and lidocaine, through the skin.
· The code for Iontophoresis is non-selectable in the system. Iontophoresis is classified by CPT and AMA as an application of a modality
· Iontophoresis is grouped with other forms of therapeutic treatment
· If Iontophoresis is the only modality of therapeutic treatment received, it can be entered utilizing the codes described as 'physical therapy'
· The root code is 93.39.1
· If Iontophoresis is one of several different modalities done in conjunction with therapy, such as chiropractic manipulation, assisting exercise or physical therapy this will be included in the therapy visit.
Labrum tear/Acetabular Labral tear of hip¶
· Entered in the system as sprain/straihip or thigh- other specified site
· Select the appropriate degree of spraiminor, moderate or severe
· The root code for the sprain/strain is 843.8
Laser Scar Revision¶
· When the treatment involves the use of a laser, the correct code to use is described as ‘Other local excision or destruction of lesion or tissue of skin or subcutaneous tissue’
· The root code for this treatment is 86.3
Massage Therapy¶
· In the system, massage therapy is categorized and entered as ‘Other physical therapy’
· You can locate all of the codes available for selection via Freeform search on the root code 93.39
MRI¶
· MRI codes are entered based on the main body part. For example, a MRI of the ankle is entered as ‘MRI of the leg’ since the ankle is part of the leg
· Other examples: the knee, hip, shoulder and wrist. The knee and hip is also part of the leg so 'MRI of the leg' would be entered. The shoulder and wrist are part of the arm, so 'MRI of the arm' is entered
Matricectomy¶
· This is removal of an ingrown nail
· In the system, use ‘Removal of nail, nail bed or nail fold’
· The codes can be found via freeform search using the keywords ‘removal nail bed’ , select Treatment and Search
· The root code is 86.23
Medial epicondylectomy¶
· Partial ostectomy of the right humerus
· The treatment code is ‘77.82.AR/AL Partial ostectomy of the humerus ’
· The treatment is only accepted by the system if there is an elbow fracture as the injury
Multiple Fractures to the Same Bone¶
When two distinct fractures occur to the same bone, both fractures should be entered as well as their treatment
Myofascial Pain Syndrome¶
· For 'Myofascial Pain Syndrome' use the Fibromyalgia codes in the system
· Myofascial Pain Syndrome and Fibromyalgia are very similar conditions
· The system medical codes are:
o 729.1.A - Fibromyalgia - diagnosed by rheumatologist, internal medicine or other medical specialist
o 729.1.B - Fibromyalgia - diagnosed by chiropractor, physical therapist or non-medical practioner
Naturopathic provider¶
· Entered in the system using the root codes of ’93.39.2 – Alternative Medicine’
· These ICD-9 codes can be used for treatment including naturopathy, herbal medicine, apiotherapy, kinesiology, holistic therapy, remedial therapy, nutritional chelation therapy, reflexology and aromatherapy
· They may also be used for any other form of alternative medicine not included above
Neurostimulator/Neurostimulation Treatment¶
· Treatment can apply to the brain or the lumbar spine
· The system has a code for the brain and for the lumbar spine
· 02.93 - Implantation of intracranial neurostimulator
· 03.93 - Insertion of spinal neurostimulatolumbar
Nosebleed¶
· The system does contain a complication code for a nosebleed. This complication is also known as ‘epistaxis’
· The can be found via freeform search using ‘nosebleed’
Nurse Practitioner or Physician Assistant Visits entered in the system as GP visit¶
· In the system, a GP visit is an office visit with a Medical Doctor (MD) who may also be known as a General Practitioner or Osteopath (DO)
· This type of visit is only captured in association with a neck/back sprain/strain injury
· Nurse Practitioners (NP) and Physician Assistants (PAs) are able to provide much of the same type of care as an MD; for the purposes of the system, since an NP/PA is not technically classified as an MD, an office visit with an NP or PA is not considered to be a GP visit
· However, an NP/PA is licensed to practice medicine and can provide much of the same care as an MD, so it is possible to consider a visit with an NP or PA as a GP visit
· This is a company decision on whether this will be considered as a GP visit in the system
Occupational Therapy¶
Occupational Therapy is not covered in the system
Orthopantogram¶
Entered in the system using ‘87.11 – Full mouth x-ray of teeth’
Personal Trainer¶
· The system does not have a medical code to cover a Personal Trainer
· If use of a Personal Trainer is accepted, then the cost should be included in the Medicals and a case note should be posted regarding the Personal Trainer
Piriformis Syndrome¶
· Piriformis Syndrome is a term used to describe pain, tingling and/or numbness in the buttock(s) and along the sciatic nerve when the piriformis muscle irritates or compresses the sciatic nerve
· The piriformis muscle is one of the deep muscles of the buttock. It runs from the sacrum to the outer hip bone and aids in external rotation of the hip. The piriformis muscle is close to the sciatic nerve, which is the largest nerve in the body and is formed from the lumbar and sacral nerve roots of the spine. The sciatic nerve passes behind the hip joint and runs down the leg/thigh. It usually passes underneath the piriformis muscle, but in some people the sciatic nerve actually passes or travels through the piriformis muscle
· Currently the system does not have a code for Piriformis Syndrome. If Piriformis Syndrome is accident related and needs to be included in the evaluation of the claim then it will need to be priced outside of the system
Pregnancy¶
· The system does not contain medical codes to account for any pregnancy related diagnostic procedures or any pregnancy complications, such as premature contractions or trauma induced abortion
· Any pregnancy related issues should be documented in Case Notes and discussed with your manager or supervisor to determine your company’s procedures on how to evaluate these treatments and/or complications
Pressure sore from cast/splint¶
· A pressure sore is an area of skin damage which results from lack of blood flow due to pressure
· In the system this complication is entered as 'decubitis ulcer' , which is sometimes also known as a bed sore. the system does not differentiate between the cause of the sore (bed or cast/splint)
· To find pressure sore in the system freeform search using the keywords 'pressure sore' or 'decubitis ulcer' along with the body part and select 'Complications' as the type
Ptosis¶
· Drooping eyelid
· Also known as blepharoptosis
· This condition is non-selectable in the system
· If it is causally related it will need to be priced outside of the system
Rib Belt¶
· A rib belt is generally used to support and stabilize the rib cage following injuries such as rib fractures
· The system does not currently contain a treatment code that specifically covers a rib belt or rib brace
Saphenous Nerve¶
· Branch of the femoral nerve which runs down the tibial side of the leg
· Any injury or treatment related to the Saphenous nerve is entered in the system using femoral nerve
· Femoral nerve injuries and treatments can be found in the system by performing a freeform search on ‘Femoral nerve’
Scar Revision¶
There are several treatments in the system that cover scar revision. Selection of the appropriate code will depend on the type of scar revision procedure done. We recommend that you review the medical record(s) regarding the procedure and then reference the the system Medical Library for the following codes:
· 86.84 (series of codes) Relaxation of scar of web contracture of skin
· 86.3 (series of codes) Other local excision or destruction of lesion or tissue of skin or subcutaneous tissuused for laser treatment
· 86.25 (series of codes) Dermabrasion; aka Dermaplaning
Sciatic¶
· The specific code for sciatica is non-selectable in the system
· Sciatica does cause referred pain in the leg(s), it is sometimes referred to as radiculopathy, particularly if there is a disc injury
· Each case will need to be evaluated on an individual basis in order to determine if a diagnosis of ‘sciatica’ can/should be entered in the system as radiculitis
SI Joint Dysfunction¶
· This is pain in the sacroiliac joint
· There is no code in the system for SI Joint Dysfunction
· If there was an injury to the sacroiliac joint which caused the pain then the injury to the sacroiliac joint should be entered
Sonogram¶
A ‘sonogram’ is the same as an ultrasound. Use the ultrasound codes with the applicable body part
Sprain/Strain Injuries (to Body Parts other than Neck& Back)¶
· Sprain/strain injuries are categorized as Minor (Grade I), Moderate(Grade II) or Severe (Grade III)
· There are times when a sprain diagnosis does not use the terminology of Minor, Moderate or Severe or even the Grade I, II or III terminology. In these cases the key is to look at the type of treatment received for the injury:
o A sprain that heals on its' own with little to no treatment should be considered a Minor, or Grade I Sprain/Strain. With a Minor Sprain/Strain, there is no indication of any type of tear or rupture
o A sprain/strain requiring Physical Therapy to heal (or maybe an injection to reduce pain) should then be considered as a Moderate, or Grade II Sprain/Strain. Also, if the medical records indicate there is a partial tear then this should be considered a Moderate Sprain/Strain
o If surgery is required to repair a sprain/strain, then this is generally considered a Severe or Grade III Sprain/Strain
· For the purpose of the system, if a partial or complete tear requires surgery to repair the tear then it is recommend the injury be entered as a ‘severe sprain/strain’
Subcapsular hematoma¶
· Subcapsular means under the capsule; capsule is an envelope-like structure enclosing an organ
· Hematoma refers to a localized collection of blood, which is usually clotted or partially clotted, situated within an organ or a soft tissue space
· Subcapsular hematoma can refer to different body parts. For example, you can have a subcapsular hematoma of the liver, spleen or kidney. If Subcapsular hematoma is diagnosed, you will need to know the body part that the diagnosis refers to
· To locate a subcapsular hematoma in the system, enter in freeform search keyword ‘hematoma’ and the body part such as, liver or spleen or kidney
Sublexed Lens¶
The system does not have a medical code for this; it will need to be priced outside of the system
Substernal hematoma
· A Substernal hematoma is a bone contusion to the sternum
· Use code ‘922.1.B – Contusion (bruise) to the bonsternum’
Sutures/Stitches¶
· Code as a treatment when used to close a wound or laceration
· No code for removal - removal is part of the wound closure treatment code
Trapezius Sprain¶
· The trapezius muscle runs from the base of the neck down to the shoulder blade and upper back
· Frequently, a trapezius sprain/strain is diagnosed in conjunction with a cervical sprain/strain
o It may be only necessary to enter the cervical sprain/strain since trapezius is part of the neck
· Each case should be assessed on its own merits along with a complete review of the medical records in order to determine the injury
· If a trapezius sprain is diagnosed, it is entered in the system as 'shoulder-sprain/strain-teres minor or other muscle/tendon'
· The root code is 840.8 and the code selection will depend on the severity of the sprain/strain
Triangular Fibrocartilage Cartilage Complex (TFCC)¶
This is a segment of cartilage in the wrist joint and is considered the meniscus of the wrist. Injuries of the TFCC include:
· Tears and perforation of the meniscus (the articular cartilage)
· Tears or ruptures of one or more of the ligaments
· Detachment of one of the ligaments from the ulna or radial point
· The code can be found by freeform search using 'TFCC ' as an injury
Turbinate reduction/Turbinectomy¶
· Removal of the turbinate bone of the nose
· This treatment is currently non-selectable in the system
Ultrasound¶
· Also knows as Sonogram or Doppler Diagnostic
· Freeform Search for Ultrasound, Sonogram or Doppler by keywords 'ultrasound' and the body part
· Blue Person Search, select body part, 'Diagnostic Procedure' as category under Treatment type
V.A.C Vacuum Assisted Closure for wound care¶
· V.A.C. is used to apply negative pressure (continuously or intermittently) in order to speed the healing of wounds. It also decreases tissue swelling, improves circulation and removes debris from the wound surface. It involves the application of foam dressing along with tubing which connects to the pump which produces the pressure
· In the system, the codes described as ‘93.59 Other immobilization, pressure or attention to wound’ can be used to for V.A.C.
Xiphoid Process Dislocation
· The system does not currently have a code that is specific to a dislocation of the Xiphoid process, which forms the inferior end of the sternum
· A dislocation/separation of the Xiphoid process can be entered as a sprain/strain
· The correct code to use is ‘848.49 – Sprain/strain sternu other including Xiphoid cartilage’
Obscure Medical Codes¶
· Feeding Tube - 46.39
· Massage Therapy (Other Physical Therapy) - 93.39
· Collapsed Lung (Pneumothorax) - 860.0.A
· Occipital Nerve Block - 83.98.A9 (New code added in 4.0 release)
· Sciatic Nerve Block - 83.98.B4B
· Home Exercises (Exercise not elsewhere classified) - 93.19 ; this code requires a Start and End Date with number of Visits
· Debridement of Rotator Cuff (Myectomy) - 83.45.C1 ; this is used when debridement is the only procedure.
Synonyms¶
· RSD (Reflex Sympathetic Dystrophy) - Complex Regional Pain Syndrome (CRPS)
· Headaches due to Whiplash/Cervical Sprain/Strain - Cerviogenic Headaches or Cephalgia
· Double Vision - Diplopia
· Nosebleed - Epistaxis
· Tinnitus - Sonitus
· Thoracic Spine - Dorsal Spine
Tricky Free Form Searching¶
· Radiofrequency Lesioning: search with 'radiofrequency' as one word
· Bone Graft from iliac: search for 'excision bone iliac'
· External Fixation Device: search on 'external fixation' plus the bone involved - for example 'external fixation humerus'. The root code is 78.1. Do not use 'external fixator'
Not Captured in the system¶
Injuries/Conditions¶
· Spinal Cord Injuries (Paraplegia/Quadriplegia)
· Severe Brain Damage
· 3rd Degree Burns
· Heart Attacks
· Strokes
· Pregnancy
· Fatalities
· Emotional only claims
· Electrocution (non-fatal)
· Sexual harassment/molestation
· Scarring/disfigurement (as only injury)
· Pregnancy complications
Treatments¶
· Home Nursing Care
· Nerve Conduction Study
· Rehabilitation & Occupational Therapy
Neck/Back Sprain/Strain Medical Codes¶
Cervical¶
847.0 Cervical Strain
89.09.GP GP Emergency Room for Cervical
93.39.1E Physical Therapy for Cervical
93.11.E Assisting Exercise for Cervical
93.20.E Chiropractic Treatment for Cervical
Thoracic¶
847.1 Thoracic Strain
89.09.GP Emergency Room for Thoracic
93.39.1F Physical Therapy for Thoracic
93.11.F Assisting Exercise for Thoracic
93.20.F Chiropractic Treatment for Thoracic
Lumbar¶
847.2 Lumbar Strain
89.09.GP Emergency Room for Lumbar
93.39.1F Physical Therapy for Lumbar
93.11.F Assisting Exercise for Lumbar
93.20.F Chiropractic Treatment for Lumbar
General Practioner/ Treating Specialist Codes¶
89.09.GP GP Visits for Cervical, Thoracic, and/or Lumbar
89.09.TS TS Visits for Cervical, Thoracic, and/or Lumbar
Remember to include the Emergency Room visit when entering number of GP visits.
Osteopath is considered a Medical Doctor
COMPLICATIONS¶
784.0.W0 Persistent headaches due to whiplash, unknown duration
784.0.W1 Persistent headaches due to whiplash, up to 1 month
784.0.W2 Persistent headaches due to whiplash, up to 2 months
784.0.W3 Persistent headaches due to whiplash, up to 3 months
784.0.W4 Persistent headaches due to whiplash, up to 4 months
784.0.W5 Persistent headaches due to whiplash, up to 5 months
784.0.W6 Persistent headaches due to whiplash, up to 6 months
784.0.W7 Persistent headaches due to whiplash, more than 6 months
Pre-existing Conditions¶
Pre-existing codes are available to enter medical conditions that the claimant had prior to the injury
The system has pre-existing codes for the spine; all the joints; Diabetes and Obesity are also available
The pre-existing conditions are classified as follows:
- Asymptomatic symptoms prior to the injury
- Symptomatic known to be treated prior to the injury
- Symptomatic not known to be treated prior to the injury
These codes will all increase the healing time, regardless of whether the condition was symptomatic or asymptomatic prior to the current injury.
The number and type of symptoms associated with the pre-existing code can increase the healing time, thereby changing the assessment. The system calculates the assessment based upon the symptom with the highest severity (the system does not add two severities together, it uses the highest number).
Spine Pre-existing codes:
721. Spondylosis (arthritis)
756. Spondylolysis
738. ,756. Spondylolisthesis
722. Pre-existing disc lesions
723. ,724. Spinal Stenosis
722.51 Degenerative Disc Disease
Three symptoms are included for the cervical and lumbar spine:
· bilateral radiculitis
· unilateral radiculitis
· pain
Arthritis Pre-existing codes:
· Shoulder
· Elbow
· Wrist
· Hand and fingers
· Hip
· Knee
· Ankle
· Foot and toes
Symptoms for the legs include :
· Limp
· Effusion (swelling)
· Pain
· Stiffness
· Crepitus (joint grinding)
Symptoms for the arms include :
· Effusion (swelling)
· Pain
· Stiffness
250 Diabetes Increases the healing time of wounds by 3-5 weeks and crush injuries by 50%
278 Obesity Increases the healing time of thoracic, lumbar and lower extremity injuries by 25%