Neurology & Pain Management Coding Alert

Hint: They’re not the same condition, despite what you might hear.

Many people outside the medical profession – and some within it – tend to interchange the terms “sprain” and “strain.” Part of the reason for this might lie in the fact that neck sprain and strain share a common code in ICD-9: 847.0 (Neck sprain) under category 847 (Sprains and strains of other and unspecified parts of back). 

The terms and conditions are not synonymous, however. ICD-10 recognizes this by providing more specific coding options that will help you report services more accurately.

ICD-10: Beginning Oct. 1, you will code for neck sprain using code family S13 (Dislocation and sprain of joints and ligaments at neck level). This code includes:

• Avulsion of joint or ligament at neck level
• Laceration of cartilage, joint or ligament at neck level
• Sprain of cartilage, joint or ligament at neck level
• Traumatic subluxation of joint or ligament at neck level
• Traumatic tear of joint or ligament at neck level.

You’ll also have codes further on for other parts of the cervical regions such as:

• S13.4xx_: Sprain of ligaments of cervical spine, …
• S13.8xx_: Sprain of joints and ligaments of unspecified parts of neck, …

Neck strain will have its own specific code in ICD-10. You’ll submit S16.1xx_ (Strain of muscle, fascia and tendon at neck level, …) for these cases. Note that each of these codes also requires one of the alphabetic characters as the seventh digit, or character extension: A (Initial encounter), D (Subsequent encounter), or S (Sequela).

Terminology check: A sprain is a stretching or tearing of ligaments — the tough bands of fibrous tissue that connect two bones together in your joints. The most common location for a sprain is in your ankle. A strain is a stretching or tearing of muscle or tendon. A tendon is a fibrous cord of tissue that connects muscles to bones.

Extra tip: As you make the shift to the new coding system, educate your providers about the separation between “sprain” and “strain,” and be sure their documentation is clear so you can report the condition accurately.