Personal Injury Topics Page

Personal Injury can be a complicated subject for all healthcare providers. This topics page contains helpful information as an additional resource to those who have purchased one of Find-A-Code's specialty-specific Reimbursement Guides or the ChiroCode DeskBook. See Chapter 1.2 - Types of Insurance Plans for explanations and definitions of important terms and subjects related to Personal Injury.

For help with supporting evidence for soft-tissues injuries, see How to Defeat IME Doctors Who Deny Your Claims.

State Law Alert: Individual states have their own specific requirements for personal injury claims. The information presented on this page is general information about these types of claims. Check with your specific state requirements to see if they vary from the information included here. CLICK HERE to review state specific information.

Resources

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CMS Publishes Over 1,000 New ICD-10-CM Codes Effective on October 1, 2022

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Each October 1st, the newest updates to ICD-10-CM take effect. This year with more than a thousand new codes added there is a lot of information to dig into and prepare our providers for. Many of the deleted and changed code descriptions, including the endeavor to capture social determinants of health, were made to enable expansion of specific coding categories so additional details could be reported, when captured in the documentation.

Addressing Trauma and Mass Violence

by  Amanda Ballif

After events of mass violence, it’s easy to feel helpless, like there is little we can do. In fact, we can help individuals, families, and communities build resilience and connect with others to cope together. The SAMHSA-funded National Child Traumatic Stress Network has developed a range of resources to help children, families, educators, and communities including the following which you can access via links in this article.

Q/A: Can I Refuse to File a Patient's Medical Insurance for an Auto Accident?

by  Wyn Staheli, Director of Content - innoviHealth

Question: Can a Chiropractor refuse to file a patients Medical Insurance for an Auto Accident? Answer: There isn't a simple answer to this question. It depends on who is responsible and state laws. Who is responsible (the auto insurance or the medical insurance) can depend on state requirements as well as who is ...

Q/A: Do Croft Guidelines Apply After Time has Passed Since the Accident?

by  Tom Grant DC, Med-Legal Consultant, Pragma Intel Director of Education

Question: Do the Croft Guidelines apply to a patient's condition immediately following the collision or are they applicable to a patient's state when they first come to see you? Whether that has been weeks or months since the collision without treatment?

Q/A: What do I do When my State Doesn't Require Pre-certifications for PI, but the Payer in Another State Does?

by  Wyn Staheli, Director of Content - innoviHealth

Question:  In Pennsylvania for Personal Injury cases we do not need to go through specific care paths or get precertification in order to treat patients, however, in New Jersey (NJ), doctors that practice there are required to get that precertification. Our question is that when we bill a New Jersey auto ...

Q/A: How Do I Release a Patient from PI When They Still Have Problems?

by  Wyn Staheli, Director of Content - innoviHealth

Once a PI patient is released with symptoms, or without symptoms, and a prognosis of likely exacerbations with a future medical estimation of $1500 over then next 2 years, how am I supposed to release them from care when they still have ongoing needs? We have discussed this with several different experts. The consensus is....

Q/A: I am Having Trouble with a Claim Rejection on my PI Claim. What do I do?

by  Wyn Staheli, Director of Content - innoviHealth

Question: I have a patient that was involved in a PI case. His lawyers are asking that we bill his insurance company first. This particular patient has xxxx insurance and the clearing house is rejecting the claim based on "ERROR 3430-Invalid principal diagnosis code." We lead with diagnosis code V43.52XA, could we change the position of the V43.52XA code? Or should we submit a paper claim for the case instead?

When is 97112 Neuromuscular Re-education Billable?

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

Q: I just received a note from an attorney regarding a patient who was rear ended about 40 mph and ended up with neuropathy in her upper and lower extremities. We treated her for about 3 months after previous care failed to give much relief. I used flexion distraction and deep muscle stimulation to break up adhesions from the injury and used the 97112 code of neuromuscular re-education. The insurance company said that code was not warranted for her spinal sprain diagnosis and denied all of the services. Do you know how I could justify it? It greatly improved her condition with each visit and the patient said we provided the greatest relief she received.

Personal Injury Information by Find-A-Code 

by  Find-A-Code™

Personal Injury is an complicated subject as it relates to medical services. This page contains helpful information as an additional resource to Find-A-Code's specialty-specific Reimbursement Guides.

Personal Injury Information by ChiroCode

by  ChiroCode™

Personal Injury is an complicated subject for all healthcare providers, including chiropractic physicians. This page contains helpful information as an additional resource to the ChiroCode DeskBook. See Chapter 1-Insurance of the ChiroCode DeskBook for explanations and definitions of important terms and subjects related to Personal Injury.
Subscribers will see related documentation, coding and billing tips. Access to this feature is available in the following products:
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  • Find-A-Code Facility Base

Select the title to see a summary and a link to the full webinar information.  some webinars require a subscription to view.

The #1 most overlooked injury in PI, and it is found in over 90% of all cases 

by  Tom Grant DC, Med-Legal Consultant, Pragma Intel Director of Education

Presented by Tom Grant Jr. DC  December 11, 2018 Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET *How to recognize this injury *The most effective documentation terms to use *The best combination of ICD-10 codes to validate it Register here: https://attendee.gotowebinar.com/register/8562161323381676035 ...

Does a Self-Care Rx Effect Medical Reimbursement and How? 

by  Tom Grant DC, Med-Legal Consultant, Pragma Intel Director of Education

This is the easiest of therapies to initiate and it adds great medical value. Most DC's do not prescribe/proscribe self-care instructions. Self-care Rx's have defined timelines for implementation and updates. Done incorrectly, self-care Rx's damage medical value and decrease reimbursements.

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