Eli's Rehab Report

Question: One of our patients, who is in rehabilitation from a stroke, was in a car accident. She came into the office immediately after the accident so I could ensure that she was OK, and I found no problems. How do I code a diagnosis? Its not exactly preventive medicine, but she had no new diagnoses.

California Subscriber

Answer: Always code for signs and symptoms, if there are any. If you find bruises on the patient, you can bill for accident-related bruises, or you can bill according to the patients complaint. For instance, if she says she got an immediate headache (784.0) after the accident, or that her lumbar spine was suddenly very sore (724.2). Rely on the Symptoms, Signs, and Ill-Defined Conditions section of the ICD-9 manual and not on the E codes, which may seem more specific to an accident, but which can never be used as the primary diagnosis. They support the primary diagnosis, to explain how and where an injury occurred.

The positive part about the signs and symptoms codes is that you can use them regardless of whether there are any positive findings in the examination. Here is the order of preference for diagnosis codes in this and similar cases:

1) injury (if present),
2) sign or symptom, and
3) observation following an accident (V71.4). (You dont need the V71.4 code if there is an injury.)

The V71.4 code can be listed first if neither of the other options is present (the patient has no damage and no complaints). Code V71.4 would be listed second if a sign or symptom is present. If injuries are present, list the injury code first and support it with E codes (the V code is no longer necessary).


Answers for You Be the Coder and Reader Questions were provided by Laureen Jandroep, OTR, CPC, CCS-P, owner of A+ Medical Management and Education, a coding and reimbursement consulting firm and a national CPC training curriculum site in Egg Harbor City, N.J.; Thomas Kent, CMM, owner of Kent Medical Management, a healthcare consulting firm in Dunkirk, Md.; and Patricia Niccoli, a chiropractic coding expert from ElectroAge Billing, a physician billing service that specializes in chiropractic reimbursement in Phoenix.