Knowing how to submit claims correctly can ease your pain. Coding for whiplash diagnosis and treatment is usually pretty straightforward. Watch for times to take extra care, however, especially if the patient's symptoms persist despite conservative therapy and warrant more extensive treatment. Watch for Move From Therapy to Scans When a patient presents with whiplash symptoms, your pain management specialist will conduct a thorough exam and will often order neck x-rays to rule out fractures. First steps: If conservative treatment fails, the physician might order additional diagnostic imaging tests. These could include: CT scans -- 70490 (Computed tomography, soft tissue neck; without contrast material), 70491 (... with contrast material[s]) and 70492 (... without contrast material followed by contrast material[s] and further sections) MRIs -- 70540 (Magnetic resonance [e.g., proton] imaging, orbit, face and/or neck; without contrast material[s]), 70542 (... with contrast material[s]) and 70543 (... without contrast material[s], followed by contrast material[s] and further sequences) Bone scans -- CT, MRI, and x-ray tests include basic bone scans. If your physician orders more extensive bone scans for the patient, you might to get authorization for 78300 (Bone and/or joint imaging; limited area) or 78305 (... multiple areas) instead. Count Trigger Point Injections Correctly Your physician might also administer trigger point injections to relieve the patient's pain and muscle tenderness. Code these procedures with 20552 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]) or 20553 (...three or more muscles). Caution: The descriptors clarify that if your provider documents a different muscle, you can count the number of muscles to determine the difference between 20552 and 20553. If, however, the provider injects multiple trigger points within the same muscle, you only count one muscle, regardless of the amount of injections. Watch point: Move to Nerve Blocks for More Pain Relief When more conservative treatments for whiplash don't help the patient enough, your physician might administer nerve blocks to help diagnose a patient's condition and/or provide therapeutic pain relief. Common options include lidocaine and/or steroids such as methylprednisolone acetate (J1020) into cervical facet joints (such as C3-4 and C4-5). Code it: Guidance: Bilateral question: Watch for Add-On Diagnoses Certain factors (age, gender, and pre-existing conditions like arthritis) can influence the severity and prognosis of whiplash injuries. When the patient does not respond to more conservative treatments or if her symptoms worsen, your physician may re-evaluate her for other disorders. In these instances, code the additional diagnoses along with whiplash. Example: Rely on Nerve Destruction as Last Recourse If nerve blocks do not bring the patient long-lasting relief, your pain specialist may consider paravertebral facet joint denervation. Document it: Some payers are beginning to require actual documentation and quantification of the patient's status, Hammer says. For example, the payer might want details regarding the percentage of change in pain, duration of pain relief, and changes in the patient's functional status during relief from the diagnostic blocks. If the patient meets these criteria, your physician may use paravertebral facet joint denervation to treat back or neck pain following whiplash/post-traumatic injury and to relieve the pain of associated cervicogenic headache. CPT includes two codes for denervation in these cases: As with nerve blocks, physicians often perform the therapeutic destructive procedures as unilateral procedures. If your specialist performs a bilateral procedure, append modifier 50 and document which joint levels he treated. Bottom line: "Whiplash may be denied for 'third-party coverage' or third-party subrogation because it often results from an auto accident," Shiley says. "It is helpful to confirm which carrier will be responsible for payment prior to performing any diagnostic tests and/or therapeutic procedures."