Physical Therapy after Car Accident: Get Patients Back on Their Feet

Physical therapy is a valuable intervention for maximizing functionality and reducing pain, especially following a car accident. However, its effectiveness largely depends on the therapist’s approach and the patient’s engagement. As a practitioner, you cannot completely control whether a patient participates; however, you can tailor a treatment plan to meet their individual needs. So, what might that look like?

Below, we’ll shed light on the value of physical therapy after car accident, the different ways physiotherapists can support their patients, and even what billing codes you might see when providing this type of care. 

Why Do Physical Therapy after Car Accidents?

Car accidents can have devastating effects that go far beyond what’s seen at the immediate scene of the crash. From physical injuries like broken bones to long-lasting psychological trauma, the gravity of their burden can’t be overlooked. 

According to research, traffic accidents are a leading cause of death and a significant source of health issues in the United States. In fact, in 2020, over two million people visited an emergency department because of a traffic accident, and nearly 40,000 individuals died. The economic and human toll of those car accidents reached approximately $430 billion in just that one year due to medical expenses, lost quality of life, fatalities, and their impact on gross domestic product (GDP). 

Each year, traffic accidents cause approximately 20 to 50 million non-fatal injuries worldwide that result in long-term disability and overwhelming financial hardship. Even further, caring for the injured often requires family members to leave their jobs or schooling, significantly worsening economic strain. Rehabilitative interventions, like physical therapy, though, could be vital in helping individuals manage and recover from their injuries.

The Economic Value of Physical Therapy 

Physical therapy can play an indispensable role after a car accident, and its benefits extend beyond solely improving patients’ functional health. The American Physical Therapy Association (APTA) has shared how the modality’s quality of life improvements can boost productivity by delivering increased economic value to patients, their family members, and society as a whole. 

Their report, The Economic Value of Physical Therapy in the United States, revealed that for certain conditions, physical therapy offers a net economic benefit to the healthcare system compared to other treatments.

• Falls prevention:  $2,144
• Acute low back pain: $4,160
• Carpal tunnel syndrome: $39,533

This highlights how effective physical therapy can be in mitigating the long-term financial burden associated with post-accident injuries, ultimately leading to a more efficient and cost-effective recovery process for both patients and the healthcare system.

Factors Affecting a Post-Car Accident Rehabilitation Plan

When it comes to designing a patient’s post-auto accident treatment plan, there’s admittedly no one-size-fits-all rehabilitation solution. The type of therapy you provide essentially hinges on certain factors, which we’ll uncover below. 

Patient-Specific Factors

As you know, no two patients are the same. Each one has unique circumstances and characteristics that can impact how well their customized treatment plan works. For example, age is a significant factor, as younger individuals tend to have faster healing rates and stronger immune systems, allowing for a quicker recovery following an auto accident. Conversely, older patients may have decreased physical resilience, thus requiring more moderate interventions. 

Besides age, other patient-specific factors you have to consider include: 

• Occupation. Patients with physically intensive jobs, such as carpenters, will require more functional training to help them safely return to work. In contrast, someone who works from home or in an office setting might benefit more from improving their posture and ergonomics. 
• Habits. Poor nutrition, smoking tobacco, excess alcohol consumption, and inadequate sleep hygiene can all hinder the healing process. 
• Pre-accident activity level. The recovery goals of a very social and physically active patient will differ from those of someone with a low-key, sedentary lifestyle. 
• Psychological state. Patients who feel anxious may worry about reinjuring themselves, or those suffering from depression may lack motivation. 
• Access to care. Clinic proximity, patient/clinic availability, and transportation can affect their ability to complete treatment.  
• Financial resources. Those with limited financial resources may struggle to pay for sessions or adaptive equipment. 

Adherence is another component that can greatly influence healing. Although techniques like exercise rehabilitation have proven to be effective, less than 35% of patients actually adhere to them. 

As a physical therapist, you’ll want to implement various strategies to help boost engagement, such as celebrating small wins, setting realistic goals, and educating patients on the importance of their actions. You can also maximize your reach with digital marketing tools that send personalized encouragement texts, appointment reminders, exercise tips, and more.  

Patient Health Assessment

In addition to taking into account the patient’s lifestyle factors, physicians and rehabilitative professionals should also conduct a thorough health assessment. This would involve reviewing a few factors.

• Medical History: Determine if they have pre-existing conditions like diabetes, cardiovascular disease, or rheumatoid arthritis that may affect the healing process. 
• Physical examination: Evaluate the patient’s range of motion (ROM), gait, strength, pain level, balance, and posture, as those elements could complicate recovery. 
• Injury type and severity: Car accidents can cause a variety of injuries, and each of them requires a different approach. Additionally, the severity of the injury impacts the intensity of your rehabilitation efforts and how patients may progress through therapy. 
• Medication review: Prescription and non-prescription drugs can affect treatment outcomes and even patient safety, so it’s crucial to thoroughly assess their medication regimen to determine if and how you may have to modify their therapy plan. Here are some common medications patients might take after a car accident, and how they may affect patients.
  • Opioids: Narcotics can cause drowsiness, slow one’s reaction time, and impair judgment, making it difficult for patients to perform functional tasks safely. 
  • Muscle relaxants: While they decrease painful muscle spasms, they can lead to generalized muscle weakness, which can increase the risk of falls, especially in older patients. 
  • Corticosteroids: The medication can accelerate bone loss, especially after prolonged use. Therapists should keep this in mind when increasing the intensity of interventions. 

The Healthcare Team

Following a car accident, interprofessional collaboration is crucial. Rehab therapists should prioritize working with other healthcare professionals to deliver safe care and the best outcomes. Even devising a physical therapy plan often requires reviewing documentation from the patient’s referring physician, as they’re the one providing the official diagnosis and specific orders. This collaboration, often supported by diagnostic imaging, lab tests, and other findings, helps confirm physical therapy as a medically necessary and appropriate treatment.

You might also work with neurologists, pain specialists, mental health professionals, and others in the healthcare space to provide coordinated patient care. 

Insurance Companies

While they’re not at the bedside performing direct care, insurers are critical to think through in the process as well. They control which services are covered, as well as the approved duration, frequency, and specific nature of physical therapy after car accident. 

For reimbursement of rehabilitative services, insurers need to understand the necessity of care. This justification typically comes from either the referring physician or the rehab provider. Diagnosis codes, specifically the International Classification of Diseases, Tenth Revision (ICD-10 codes), are crucial here. These codes precisely identify the patient’s injury, clearly explaining to the insurer why physical therapy is needed.

The specific services provided are then itemized using Current Procedural Terminology (CPT) codes. Insurers use these codes and associated documentation to determine their reimbursement to the physical therapist and the patient’s out-of-pocket responsibility.

Code linkage is also essential. The CPT codes for services rendered must directly correspond to the patient’s ICD-10 diagnosis codes. Without this direct connection, a claim for a car accident injury treatment could be denied. 

Physical Therapy Strategies for Car Accident Injury Treatment

Now that we’ve covered which factors rehab professionals have to be wary of, it’s time to determine which modalities you might apply. Car accidents can cause a variety of injuries, so the type of therapy you provide essentially depends on what the patient experienced. 

For instance, research indicates that frontal and near-side collisions commonly result in head, neck, chest, and abdominal injuries. Additionally, T-bone and lateral impacts are more likely to cause shear injuries to the aorta or organs, alongside fractures of the pelvis, neck, collarbone, and skull on the impact side. And rear impacts are associated with an increased risk of neck flexion-extension injuries and chance fractures of the spine.

With these things in mind, let’s review the rehab techniques you could apply for three of the most common injury types. In addition to that, we’ll share the ICD-10 and CPT codes that might be used in insurance claims.  

Whiplash 

When the head is suddenly jerked backward and then forward, it can cause whiplash, a condition frequently brought about by car accidents. The ICD-10 code for this condition is S13.4XXA, but should be accompanied by V89.2XXA, which explains that a person was injured in an unspecified motor-vehicle accident in a traffic setting. 

This forceful neck movement can stretch and tear the soft tissues of the neck and upper back, leading to symptoms like numbness, limited ROM, tingling in the arms, shoulder pain, and more. A physical therapist would want to focus on alleviating these symptoms and might apply some of the following techniques to do so.

• Transcutaneous Electrical Nerve Stimulation (TENS): Done to reduce pain and muscle spasms
  • If the physical therapist is present for the entire duration of electrical stimulation therapy, use CPT Code 97032
• Light massage therapy or soft tissue mobilization: This treatment helps boost circulation in the affected areas
  • The CPT code for manual therapy on one or more regions for 15 minutes each is 97140
• ROM exercises: Neck rotations, neck tilts, shoulder rolls, and chin tucks may help improve flexibility
  • If the therapist is directly involved in providing therapeutic exercises for 15 minutes, you can use the time-based CPT code 97110

Back Pain

The impact during a motor vehicle accident can cause sudden and immense forces capable of straining muscles and ligaments, often those in the mid or lower back. They could even bring about more severe injuries to the spinal discs by causing them to rupture, shift, or compress. 

ICD-10 coding for back pain is complex, as it hinges on the pain’s precise location, underlying etiology, and any associated symptoms. For illustrative purposes, though, let’s consider back pain resulting from a traumatic cervical disc herniation, coded as S13.1XXA. Patients presenting with a herniated disc may experience sciatica, as well as numbness or tingling. This injury can lead to restricted movement and significant discomfort in patients, impacting their social life and work performance. 

Physical therapists should aim to help these patients with pain reduction, core strengthening, and spinal mobility, enabling them to return to their daily activities. This might involve some of the following techniques: 

• Heat/cold therapy to decrease pain and swelling
  • The CPT code 97010 is used when a hot or cold pack is applied to a specific location on the body to treat a disease or injury, but keep in mind that insurers may not provide separate reimbursement for this code, as they often see it as a bundled service
• Nerve gliding exercises and postural training, which together help alleviate nerve irritation and improve spinal alignment
  • Both interventions are considered therapeutic procedures and use the CPT code 97112, covering physical therapists conducting neuromuscular reeducation exercises aimed at decreasing impairments and restoring function
• Functional training activities include folding laundry, washing dishes, reaching into a cupboard, or other daily activity tasks a patient might struggle with following a car accident
  • Use CPT code 97530 for therapeutic activities, which covers dynamic activities aimed at improving a patient’s ability to perform daily tasks

Fractures 

After a patient’s broken bones have healed, physical therapy can be incorporated to help them regain joint mobility and strengthen muscles. Like back pain, there’s not just one ICD-10 code for fractures either. Coding fractures requires a high level of specificity, as it depends on the type of fracture, the bone itself, the bone’s location, and more. 

It would be impossible to discuss every type of fracture in just a blog post, so let’s focus on an example where the patient’s cast has been removed after experiencing a closed, displaced fracture of the shaft of the right tibia. If it’s a subsequent encounter for their fracture requiring routine healing, the best ICD-10 code for this would be S82.221D. You should also apply the appropriate code within the V40-V49 range, which explains that a car occupant was injured in a transport accident. 

To help the patient return the fracture site to normal function, rehabilitation therapists could implement these modalities.

• Neuromuscular Electrical Stimulation (NES): Helps strengthen muscles after they’ve been immobilized
  • Use CPT code 97032 for the manual application of electrical stimulation
• Thermal ultrasound: Heating of the deep tissues promotes tissue healing at the cellular level
  • Apply the time-based CPT code, 97035, which covers the application of therapeutic ultrasound
• Progressive strengthening exercises: Hamstring curls, lunges, squats, and more can build the patient’s weight-bearing tolerance
  • Apply CPT code 97110 for therapeutic exercises

The Physical Therapy after Car Accident Requires Careful Treatment

As shared here, physical therapy after a car accident isn’t just about helping patients feel and function better; it also offers an economic benefit. However, for patients and practitioners to see such results requires careful assessment, collaborative efforts, and applying the most effective interventions for the injury type. Plus, it helps to have knowledge of how to maximize reimbursements to help you boost your bottom line. 

Nonetheless, we understand that there’s only so much time in a day, so rehab providers could try to maximize their efforts using technology. A robust electronic medical record (EMR), for instance, could help automate workflows, predict patient outcomes, and optimize reimbursements, allowing your team to do more without increasing their workload.