Updated on: March 14, 2016

ICD-10 Whiplash

Original story posted on: October 24, 2013

A few weeks ago, while teaching an ICD-10 seminar for chiropractic doctors, one physician asked me if ICD-10 solved the sprain/strain issue that exists under ICD-9. Frankly, I was not familiar with the problem, so I did a little digging.


Chiropractic physicians frequently treat individuals who sustain soft-tissue neck injuries in automobile accidents or other traumas. In ICD-9, these conditions frequently are coded with:

847.0, Sprains and strains of; neck
Anterior longitudinal (ligament), cervical
Atlanto-axial (joints)
Atlanto-occipital (joints)
Whiplash injury

 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:

S16.1XXAStrain 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. 

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.

Evan M. Gwilliam, DC, MBA, BS, CPC, CCPC, CCCPC, NCICS, CPC-I MCS-P, CPMA, executive vice president of ChiroCode and Find-A-Code LLC, graduated from Palmer College of Chiropractic as valedictorian and is a certified professional coding instructor, medical compliance specialist, and professional medical auditor, among other things. He provides expert witness reports, medical record audits, consulting, and online courses for healthcare providers. He also writes books and articles for trade journals and is a sought-after seminar speaker. He has a bachelor’s degree in accounting and a master’s of business administration, and he is one of the few clinicians who is a certified ICD-10 Instructor and certified MACRA/MIPS healthcare professional.