ICD-10 Coding for Below-Knee Amputation(Z89.511, Z89.512, Z89.519)
Complete ICD-10-CM coding and documentation guide for Below-Knee Amputation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Below-Knee Amputation
Z89.51-Z89.52Primary Range
Acquired absence of leg below knee
These codes are used to document the status post-amputation of the leg below the knee.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Z89.511 | Acquired absence of right leg below knee | Use when documenting a healed right below-knee amputation with prosthetic use. |
|
| Z89.512 | Acquired absence of left leg below knee | Use when documenting a healed left below-knee amputation. |
|
| Z89.519 | Acquired absence of unspecified leg below knee | Use when laterality is not specified in documentation. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for below-knee amputation
Essential facts and insights about Below-Knee Amputation
Primary ICD-10-CM Codes for amputation below knee
Decision Criteria
documentation Criteria
- Document laterality and prosthetic status.
Applicable To
- Healed right BKA with prosthetic use
Excludes
- Active treatment of amputation site
Clinical Validation Requirements
- Operative report
- Current residual limb measurements
- Prosthetic fit notes
Code-Specific Risks
- Incorrect laterality documentation
Coding Notes
- Ensure laterality is clearly documented.
Z89.512 - Acquired absence of left leg below knee
Use when documenting a healed left below-knee amputation.
Applicable To
- Left transtibial amputation
Excludes
- Active treatment of amputation site
Clinical Validation Requirements
- Operative report
- Current stump measurements
Coding Notes
Ensure laterality is clearly documented.
Z89.519 - Acquired absence of unspecified leg below knee
Use when laterality is not specified in documentation.
Applicable To
- Bilateral BKAs without laterality specified
Excludes
- Active treatment of amputation site
Clinical Validation Requirements
- Operative reports
- History of bilateral amputations
Coding Notes
Avoid using unspecified codes when possible.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Complete traumatic amputation at level between knee and ankle, right lower leg, initial encounter
S88.111AComplete traumatic amputation at level between knee and ankle, left lower leg, initial encounter
S88.112AComplete traumatic amputation at level between knee and ankle, unspecified lower leg, initial encounter
S88.119ADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Below-Knee Amputation to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z89.511.
Impact
Clinical: May lead to incorrect treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Always specify left or right in documentation., Use templates that prompt for laterality.
Impact
Reimbursement: May affect DRG assignment and reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Reduces data accuracy and quality.
Mitigation Strategy
Query the provider for clarification on laterality.
Impact
Reimbursement: Incorrect CPT code selection may lead to underpayment., Compliance: Non-compliance with coding standards., Data Quality: Inaccurate procedural data.
Mitigation Strategy
Ensure surgical technique is clearly documented.
Impact
Using unspecified codes can trigger audits due to lack of specificity.
Mitigation Strategy
Ensure documentation includes all necessary details to use specific codes.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Below-Knee Amputation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Below-Knee Amputation
Use these documentation templates to ensure complete and accurate documentation for Below-Knee Amputation. These templates include all required elements for proper coding and billing.
Post-operative BKA follow-up
Specialty: Vascular SurgeryRequired Elements
- Amputation status
- Residual limb length
- Stump characteristics
- Prosthetic use
- Comorbidities
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Below-Knee Amputation? Ask your questions below.