Treatment of Accidental Injury to the Spine and Back

Care Path

Diagnosis Coding

 

The following International Classification of Diseases, 9th Revision Clinical Modification - fifth edition ICD-9-CM diagnostic codes are associated with Care Path 1 through Care Path 6 for treatment of Accidental Injury to the Spine and Back and are included on each appropriate Care Path. The ICD9 codes referenced do not include codes for multiple diagnoses or co-morbidity.

Care Path 728.0 Disorders of muscle, ligament and fascia

1 728.85 Spasm of muscle

739.0 Non allopathic lesions - not elsewhere classified

739.1 Somatic dysfunction of cervical region

847.0 Sprains and strains of neck

847.9 Sprains and strains of back, unspecified site

922.3 Contusion of back

922.31 Contusion of back, excludes interscapular region

953.0 Injury to cervical root

Care Path 722.0 Displacement of cervical intervertebral disc without myelopathy

2 722.2 Displacement of intervertebral disc, site unspecified, without myelopathy

722.70 Intervertebral disc disorder with myelopathy, unspecified region

722.71 Intervertebral disc disorder with myelopathy, cervical region

728.0 Disorders of muscle, ligament and fascia

739.0 Non allopathic lesions - not elsewhere classified

953.0 Injury to cervical root

Care Path 728.0 Disorders of muscle, ligament and fascia

3 728.85 Spasm of muscle

739.0 Non allopathic lesions - not elsewhere classified

739.2 Somatic dysfunction of thoracic region

739.8 Somatic dysfunction of rib cage

847.1 Sprains and strains, thoracic

847.9 Sprains and strains of back, unspecified site

922.3 Contusion of back

922.33 Contusion of back, interscapular region

Care Path 722.0 Displacement of cervical intervertebral disc without myelopathy

4 722.1 Displacement of thoracic or lumbar intervertebral disc without myelopathy

722.11 Displacement of thoracic intervertebral disc without myelopathy

722.2 Displacement of intervertebral disc, site unspecified, without myelopathy

722.70 Intervertebral disc disorder with myelopathy, unspecified region

722.72 Intervertebral disc disorder with myelopathy, thoracic region

728.0 Disorders of muscle, ligament and fascia

739.0 Non allopathic lesions - not elsewhere classified

Care Path 728.0 Disorders of muscle, ligament and fascia

5 728.85 Spasm of muscle

739.0 Non allopathic lesions - not elsewhere classified

739.3 Somatic dysfunction of lumbar region

739.4 Somatic dysfunction of sacral region

846 Sprains and strains of sacroiliac region

846.0 Sprains and strains of lumbosacral (joint) (ligament)

846.1 Sprains and strains of sacroiliac ligament

846.2 Sprains and strains of sacrospinatus (ligament)

846.3 Sprains and strains of sacrotuberous (ligament)

846.8 Sprains and strains of other specified sites of sacroiliac region

846.9 Sprains and strains, unspecified site of sacroiliac region

847.2 Sprains and strains, lumbar

847-3 Sprains and strains, sacrum

847.4 Sprains and strains, coccyx

847.9 Sprains and strains, unspecified site of back

922.3 Contusion of back

922.31 Contusion of back, excludes interscapular region

953.2 Injury to lumbar root

953.3 Injury to sacral root

Care Path 722.1 Displacement of thoracic or lumbar intervertebral disc without myelopathy

6 722.10 Displacement of lumbar intervertebral disc without myelopathy

722.2 Displacement of intervertebral disc, site unspecified, without myelopathy

722.70 Intervertebral disc disorder with myelopathy, unspecified region

722.73 Intervertebral disc disorder with myelopathy, lumbar region

728.0 Disorders of muscle, ligament and fascia

739.0 Non allopathic lesions - not elsewhere classified

953.3 Injury to sacral root

The following ICD-9-CM supplemental classification of external causes of injury may be used in addition to the specific diagnostic codes noted above and on each Care Path:

    • E 810 through E 819, selected E 820 series codes.

These codes may be used to indicate cause of injury as motor vehicle accident but should not be used without an associated diagnostic code.

ADDENDUM TO CARE PATHS

1. Medications

Muscle Relaxants

      • Muscle relaxants are an option in the treatment of patients with acute neck, thoracic, and low back problems. While probably more effective than placebo, muscle relaxants have not been shown to be more effective than NSAIDs.
      • No additional benefit is gained by using muscle relaxants in combination with NSAIDs over using NSAIDs alone.
      • Muscle relaxants have potential side effects in 30 percent of patients. When considering the option of using relaxants, the clinician should balance the potential patient's intolerance of other agents.

Opioid Analgesics

      • When used for a time-limited course, opioid analgesics are an option in the management of patients with acute neck, thoracic, and low back problems. The decision to use opioids should be guided by consideration of their potential complications relative to other options.
      • Opioids appear to be more effective in relieving neck, thoracic, and low back symptoms than safer analgesics, such as acetaminophen or aspirin or other NSAIDs.
      • Clinicians should be aware of the side effects of opioids, such as decreased reaction time, clouded judgment, and drowsiness, which lead to early discontinuation by as many as 35 percent of patients.
      • Patients should be warned about dependence and the danger of opioids while operating heavy machinery.

Oral Steroids

      • Oral steroids are not recommended for the treatment of acute neck, thoracic, or low back problems.
      • A potential for severe side effects is associated with the extended use of oral steroids or steroids in high doses.

2. Who May Perform Spinal Manipulation:

Spinal manipulation may be performed by those providers licensed or certified to perform this procedure within their scope of practice.

3. Spinal Manipulation/Chiropractic Care

A course of spinal manipulation/chiropractic care may be considered as conservative therapy on all Care Paths. If there is no improvement within one month, then immediate reevaluation is indicated to determine appropriate further treatment and treatment options, including referral to other health care providers and/or modification of conservative therapy..

When findings suggest progressive or severe neurologic deficits, an appropriate diagnostic assessment to rule out serious neurologic conditions is indicated in any conservative therapy.

4. Mental Health/Rehabilitation Assessment Option If Patient Has Not Responded To Treatment

A mental health/rehabilitation assessment can be obtained if psychological/ psychosocial or psychiatric distress is obvious from the history, i.e., presence of "non-organic" physical signs, repetitive back injuries, failed previous treatments, litigation or disability compensation claims, family or financial problems, apparent secondary gain, boredom and dissatisfaction with job, frequent bouts of pain, depression, alcohol and substance abuse, extreme obesity, and apparent psychiatric behavior.

Published: May 21, 1999
Amended: November 29, 2000