Ever wonder what those personal injury medical codes are in your medical bills and why they are important to your personal injury
case? For example, a code might look like: “ICD S42.402A.” Those codes actually mean something and can be very important to the success of your personal injury case. For help figuring out these codes, contact our office for a free consultation at 312-848-9783.
Personal injury medical codes
For many years, medical providers and insurance companies have been using personal injury medical codes called “ICD Codes” to document the diagnoses of medical patients. ICD stands for International Classification of Diseases. If you are interested in looking up what the diagnosis is of your injury, check out this ICD website – www.icd10data.com. This is the site we use to figure out ICD codes. The reason behind using codes like this is to create uniformity within the medical world. It’s also used by auto insurance companies – many times to reduce the amount of your claim.
ICD codes were created by the World Health Organization and there have been 10 versions of ICD Codes. ICD 11 codes are currently being created. A huge jump in the number of classified diagnoses/diseases etc. occurred in the change from ICD 9 to ICD 10. ICD 9 had approximately 14,000 classification codes. ICD 10 has approximately 70,000 codes.
The biggest difference between 9 and 10 is that ICD 9’s were generic. For example, this is an ICD 9 code: “812.40 – Closed fracture of unspecified part of lower end of humerus.” Note that there is no indication whether this applies to the left or right arm and does not state whether this is the first medical visit for this issue or a subsequent visit.
Conversely, the ICD 10 code for the same injury is “S42.402A – Unspecified fracture of lower end of left humerus, initial encounter for closed fracture.” The left arm is specifically indicated as is where in the treatment process the visit occurred (initial encounter).
If you were involved in an accident and received treatment prior to September 30, 2015, use ICD 9 codes. For all injuries from October 1, 2015 and after, use ICD 10 codes.
Why are personal injury medical codes important to my case?
Many auto insurance companies use personal injury “calculators” to assess the value of your case. The most known tool is called “Colossus.” Insurance adjusters take your medical bills and everything else about your case and enter it into the software and it comes back with a settlement range within which to resolve your case.
One piece of data that insurance adjusters enter into their software programs are ICD codes. When we do a demand letter to an insurance company, we always document what ICD Codes we want entered for them. That way you can avoid a situation where an insurance adjuster misses a relevant personal injury code.
For example, in a demand letter we might insert the following:
“Emergency Room Visit
Dr. Smith instructed Ms. Jones to take Prednisone and Tylenol for pain and to return to his office in four to five days if her symptoms increased. Dr. Smith also instructed Ms. Jones to undergo x-rays of her thoracic spine which Ms. Jones dutifully did on June 20, 2017, the results of which were negative.
- M62.830: Muscle spasm of back
- M54.2 Cervicalgia
- M54.6: Acute right-sided thoracic back pain
- V89.2XXA: MVA, initial encounter”
Pros and Cons of personal injury medical codes
The idea behind using ICD Codes (and personal injury calculators) makes some sense. It provides uniformity within a system. And using ICD 10 codes provides for very specific detailing of diagnoses.
However, ICD Codes can be a pain to work with. Often, they are not listed on medical bills or in the records and you have to find them yourself online.
Also, ICD Codes are descriptive as to an official diagnosis, but they don’t measure the effect the diagnosis has on a person. In fact, it can hurt your case. For example, if you are diagnosed with a back strain or sprain – a soft tissue injury – you can be sure that the offer from the insurance company is going to be fairly low.
ICD Codes (and/or programs like Colossus) cannot measure the degree of your pain and suffering as a result of an injury. People who suffer strains and sprains can suffer significant pain and discomfort for a long period of time but that will not be reflected no matter what ICD Code you use.
Also, there is no ICD Code for aggravation or exacerbation of an injury. As such, if you had a pre-existing back injury, get rear ended, and this exacerbates your pain and discomfort, there is no ICD Code you can point to in order to explain the situation. The ICD Code will simply document “back sprain/strain.”
Pro Se Representation
Often our clients receive medical bills and send them to us. The medical bills that you receive in the mail normally do NOT include ICD Codes. As such, if you represent yourself, when you obtain your bills, make sure you request bills with the ICD Codes.
If you get injured in an accident and you want to talk to an attorney about your case, or you want clarification about how to use personal injury medical codes, feel free to contact us for a free consultation at 312-848-9783.