ICD-10 Coding for Anterior Cruciate Ligament Reconstruction(S83.53-, M23.5-)
Complete ICD-10-CM coding and documentation guide for Anterior Cruciate Ligament Reconstruction. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Anterior Cruciate Ligament Reconstruction
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S83.53- | Traumatic rupture of anterior cruciate ligament | Use for acute ACL injuries confirmed by imaging and clinical tests. |
|
| M23.5- | Chronic instability of knee | Use for chronic ACL insufficiency with long-term instability. |
|
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 ACL reconstruction
Essential facts and insights about Anterior Cruciate Ligament Reconstruction
Primary ICD-10-CM Codes for anterior cruciate ligament reconstruction
Decision Criteria
clinical Criteria
- Acute injury with MRI and Lachman test confirmation.
Applicable To
- Acute ACL tear
Excludes
- Chronic ACL insufficiency (M23.5-)
Clinical Validation Requirements
- MRI confirmation of ACL tear
- Positive Lachman test
Code-Specific Risks
- Incorrectly coding chronic conditions as acute.
Coding Notes
- Ensure acute injury is documented with appropriate clinical findings.
M23.5- - Chronic instability of knee
Use for chronic ACL insufficiency with long-term instability.
Applicable To
- Chronic ACL insufficiency
Excludes
- Acute ACL tear (S83.53-)
Clinical Validation Requirements
- Documented instability over 6 months
- Failed conservative management
Coding Notes
Ensure chronic instability is well-documented with clinical history.
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.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Anterior Cruciate Ligament Reconstruction to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S83.53-.
Impact
Clinical: May lead to incorrect coding and treatment records., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Use detailed templates for operative notes., Ensure all procedural details are documented.
Impact
Reimbursement: May result in lower reimbursement if complexity is not documented., Compliance: Risk of non-compliance with coding standards., Data Quality: Inaccurate representation of procedure complexity.
Mitigation Strategy
Use 29888-22 for complex revision procedures.
Impact
Incorrect use of modifiers can lead to audits.
Mitigation Strategy
Ensure correct modifier application with supporting documentation.
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 Anterior Cruciate Ligament Reconstruction, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Anterior Cruciate Ligament Reconstruction
Use these documentation templates to ensure complete and accurate documentation for Anterior Cruciate Ligament Reconstruction. These templates include all required elements for proper coding and billing.
Standard ACL Reconstruction
Specialty: Orthopedic SurgeryRequired Elements
- Procedure type
- Graft source
- Fixation method
- Tunnel positions
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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