Neurosurgery Coding Alert

Check LCDs for what group of codes may allow you more numbers of patient visits.

ICD-10 brings you a range of codes for reporting the diagnosis of thoracic sprains and strains. Learn to think beyond the spine when treating a patient of thoracic spinal injury. You will need elaborate and specific documentation to make sure you do not lose focus in the plethora of codes for thoracic sprains and strains. Here is why ICD-10 offers better options and a listing of codes which you can choose from.

ICD-9 options: In ICD-9, when needing to report the strains and sprains of thorax, you had to resort to 847.1 (Thoracic sprain). This was essentially a “blanket” code that included avulsion, hemarthrosis, laceration, rupture, sprain, strain, tear of joint capsule, ligament, muscle, and tendon related to the thorax.

Another code you sometimes reported was 848.8 (Other specified sites of sprains and strains).

ICD-10 options: However, in ICD-10, we have multiple specific codes that more precisely describe the anatomical location of the injury.

Thoracic strain: ICD-10 includes more than 12 codes exclusively for strain of the thorax.

In the broad category S20-S29 (Injuries to the thorax), the S29.01 category represents “Strain of muscle and tendon of thorax.” Nine more codes allow a more detailed description of the strain, including whether it is in the front or rear aspect of the thorax, and an unspecified code in case the provider does not mention the site. The digit after the decimal point represents the subcategory code describing the site, etiology, manifestation, or state of the disease or condition.

• S29.011A/D/S: Strain of muscle and tendon of front wall of thorax, initial encounter/subsequent encounter/ sequela
• S29.012A/D/S: Strain of muscle and tendon of back wall of thorax, initial encounter/subsequent encounter/ sequela
• S29.019A/D/S: Strain of muscle and tendon of unspecified wall of thorax, initial encounter/ subsequent encounter/ sequela

Thoracic sprain: Thoracic sprain has exclusive codes reserved for itself. In the broad category S20-S29 (Injuries to the thorax), S23._ represents dislocation and sprain of the joints and ligaments of the thorax. Again, nine additional codes allow a more detailed description of the sprain, and an unspecified code to designate in case the provider does not mention the site. The seventh character can assume value A, D, or S, depending on whether the patient presents for an initial encounter, subsequent encounter, or a sequela (a condition resulting as a consequence of the injury). For example:

• S23.3XXA/D/S: Sprain of ligaments of thoracic spine, initial encounter/subsequent encounter/ sequela
• S23.8XXA/D/S: Sprain of other specified parts of thorax, initial encounter/subsequent encounter/ sequela
• S23.9XXA/D/S: Sprain of unspecified parts of thorax, initial encounter/subsequent encounter/ sequela

Good news: If you are familiar with the LCD (local coverage determination), certain diagnosis codes are assigned to groups. Certain groups allow for more manipulations. Group M54.6 for pain in the thoracic spine would only allow 12 visits, but S23.3XXA for an initial encounter to treat sprain of ligaments of thoracic spine would allow for 18.  “The increased specificity of ICD-10 allows more subtle differentiation among diseases and injuries, allowing for more refined coverage policies,” says Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.