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.


SS Disability Childhood listings (Part A)

Criteria to evaluate impairments over age 18

SS Disability Childhood listings (Part B)

Criteria to evaluate impairments under age 18

Select the title to see a summary and a link to the full article.

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


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?


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?


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?


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?


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?


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.

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Subscribers will see the tips about using this code for billing and reimbursement.Access to this feature is available in the following products:
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Select the webinar title to view a summary and link to the webinar video.

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

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: ...

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Posture Rehab and Motor Control Exercise

Join the Posture Expert, Dr. Steven Weiniger, and find out why the American College of Physicians recommends motor control exercise (MCE) for low back pain over drugs and surgery. Learn how StrongPosture® MCE protocols synergizes with chiropractic by correlating the individual’s unique perceptions with objective benchmarks to systematically correct sensorimotor errors and functionally strengthen posture.

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How to Use Medical Codes for PI Care

Can you or can you not use “medical” codes (fracture, surgery, illness, etc.) for PI care? Is it legal? Why would you even consider them?

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Liens and PI care — How to Make Them Work Better...

Liens have been the salvation and anathema for doctors involved in personal injury care treatments. While an essential part of extending needed injury recovery care to those whose insurance coverage is minimal to non-existent, they are not a fool-proof way to secure reimbursement. How do you protect yourself against insurers and attorneys who refuse to honor the agreement? This webinar will explore various methods that have proven to be successful in enforcing a lien to secure reimbursement of your skillful services.

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Trauma and the Presence of Effusion or Edema

How do you document them? What PI codes do you use to report them? What PI codes do you use to validate them? Can they both be present at the same time? How do you treat them? As a Med-Legal Consultant & Strategist, Chiropractor, PI Practice Coach, Speaker, Author, Inventor, Educator and entrepreneur, Dr. Grant’s mission is to help professionals gain greater confidence, skill, & strength to successfully deliver the best recovery care and provide powerful claim strategies for traumatically injured patients.

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Contusion Confusion - PI's Great Overlooked and Misused Finding

Each injury has a set of confirmatory symptoms that can be used to convey severity. Contusions are one of the easiest to report, but not always the easiest to find. Most contusions are not being recognized. The truth is that they are very prevalent and they are not being documented properly by DC's. This webinar will help you expand your diagnostic skills for contusion discovery and give you insight on how to document, validate, treat and code for contusions.

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