Personal Injury Medical Codes

Ever wonder what those personal injury medical codes are in your medical bills and why they are important to your personal injury

Personal Injury
Personal Injury Medical Codes

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.

ICD Codes:

  • 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.

Social Media as Evidence

Bottom line, be careful what Social Media as Evidence

In most personal injury cases, this issue of whether you can use social media as evidence comes up often. In this

Social Media as Evidence

article we’re going to do discuss what you should and should not do with regard to your Facebook, Instagram and other social media accounts. If you have any questions about this issue or you have been involved in an accident, contact our office for a free consultation at 847-305-4105.

Social Media as Evidence

Personal injury cases are won and lost based on evidence. In the past, this was restricted to witness testimony, the statements of the parties involved, and the written documents, usually in paper form, that supported your case.

Today, evidence is totally different. While the above sources are still available, the first place we look today for evidence is online. Our clients were involved in automobile, slip and fall, or other types of accidents. Most of our clients have social media accounts as do most of the people involved in the accidents with our clients. As such, when we get a call from a new client, the first thing we do is look them up on the internet. The most abundant source of information comes from Facebook.

Statistics

Facebook has more than 1 billion daily active users. YouTube has 1.5 billion active monthly users. These people are posting content online at an astounding rate. And they spend an enormous amount of time online. It’s estimated that the average person spends five hours a day on their mobile device. Most of that time is spent on apps. We’re now spending more time on apps than we spend watching television.

Criminal Conduct

This corresponds with an increase in criminal conduct on Facebook. On Facebook Live, there have been at least 45 instances of violence, such as rape and murder, broadcast live. What is wrong with these people?

Personal Injury Cases

Our firm does not practice criminal law, we are a civil practice. Our cases do not involve incarceration, but rather financial compensation for our clients who were victims of accidents. Most of our clients have Facebook or other social media accounts, as do the people who caused their accident. We look every one of them up.

Social Media as Evidence – Example

Believe us, if we are checking your social media, so are insurance adjusters. And the insurance adjuster’s sole job is to pay you as little as they can for your injuries. As such, we advise all our clients not to post excessively on Facebook about your accident. And, be wary of what you post period.

We had a case where our client suffered a real knee injury as a result of a motorcycle collision that was not his fault. He underwent significant medical treatment (not surgery) and physical therapy. The medical records were filled with references to his pain and discomfort.

Unfortunately, at the same time our client was reporting pain in his knee to his physical therapist, he continued to engage in a very active lifestyle that included working on small, personal helicopters. He posted photos of him engaging in this activity on Facebook. He was bending down, working on the engine, bending over, carrying things, flying the helicopter and so on. Sure enough, the insurance adjuster looked him up on Facebook. They used his social media as evidence against us. Because of this, the adjuster scoffed at our demands and we were forced to resolve the matter for far less than it would have been worth but for the social media evidence.

We have also used social media as evidence against the person who caused the collision. People often admit fault on Facebook. We’ve seen posts where people admitted they ran a stop light or didn’t see someone before an accident. All we had to do is take a screenshot of those posts to enable us to capitalize on them. Ultimately, we would have to authenticate them as evidence in court if the matter went that far. But that is not the topic of this article.

Other Electronic Evidence

As an aside, other forms of electronic evidence are excellent as well. We’ve had several cases where our clients and the defendants who caused their injuries texted about the collision after it happened. We’ve had more than one occasion where a defendant admitted fault in a text. In one case, the defendant, a young woman, admitted she was texting while she was driving and as a result did not see our client. She lied to her insurance company and told them she was blinded by the sun. This did not go well for her.

Conclusion

Bottom line, be careful what you post online as the insurance company or attorneys involved will use your social media as evidence against you. If you have any questions about the use of social media, feel free to contact our office for a free consultation at 847-305-4105.