The “includes” note lists rupture, sprain, strain, or tear of the joint capsule, ligament, muscle, and/or tendon. The trouble with this code, as with many ICD-9 codes, is that it is not very specific. It includes both sprains and strains. When a ligament is stretched beyond its capacity, the injury is classified as a sprain. Ligaments are similar to tendons in that they are made up of collagen, except ligaments attach bone to bone, whereas tendons attach muscle to bone. When a muscle or tendon suffers the same fate, it is classified as a strain.
These conditions frequently occur simultaneously, but not always. The tissue is collagen in both cases, and the symptoms of the injuries are similar. However, the type of tissue involved can have a very different histological makeup. Tendons and muscles tend to be more elastic and have a better blood supply than ligaments. Tendon fibers rest parallel to each other for flexibility, while ligament fibers tend to criss-cross each other for strength. Treatment is often very similar for each condition, but it may be possible that a provider or therapist would want to customize the therapeutic exercises so they facilitate the most effective healing method for each type of tissue. Tendons also may heal more quickly than ligaments, a product of the aforementioned enhanced blood supply.
The ICD-9 “whiplash dilemma” is that the code makes no distinction between the two injuries. A physician recently asked me if ICD-10 had a better solution. As I taught about what can be learned from GEMs (General Equivalence Mappings), I pointed out that there are two codes crosswalked to 847.0:
S13.4XXA Sprain of ligaments of cervical spine, initial encounter
Sprain of anterior longitudinal (ligament), cervical
Sprain of atlanto-axial (joints)
Sprain of atlanto-occipital (joints)
Whiplash injury of cervical spine
S13.8XXA Sprain of joints and ligaments of other parts of neck, initial encounter
The first code is nearly identical to the ICD-9 code. However, both of these options only list “sprain” and make no mention of “strain.” In order to find out if there is a nice “strain” code for the neck, one must search the ICD-10 alphabetic index. The code that turns up is:
S16.1XXA - Strain of muscle, fascia and tendon at neck level, initial encounter
It appears that there is indeed a separate “strain” code for the neck. Interestingly, when GEMs are used to investigate the ICD-9 code, it points back to 847.0 once again. The path from ICD-9 to ICD-10 does not lead to the strain code, but the ICD-10-to-ICD-9 crosswalk does go back to where one might expect. This is another example of how GEMs can be useful but limiting at the same time.
All of this matters to the clinician because the treatment protocols may differ for a patient with a strain versus one with a sprain. The healing time for each injury may be different because. It is important to be able to communicate that to a third party so it can adjudicate the claim properly.
ICD-10 once again is proving that it can do a better job of taking care of patients than ICD-9 ever could.
About the Author
Evan M. Gwilliam is the director of education and consulting for ChiroCode Institute. Dr. Gwilliams holds multiple coding certifications and graduated from the Palmer College of Chiropractic in 2003 as valedictorian. He teaches seminars across the country for chiropractic offices.
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