ICD-10 Coding for Anterior Cruciate Ligament Injury(S83.511A, M23.521)
Complete ICD-10-CM coding and documentation guide for Anterior Cruciate Ligament Injury. 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 Injury
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S83.511A | Sprain of anterior cruciate ligament of right knee, initial encounter | Use for initial encounter of acute ACL tear in the right knee. |
|
| M23.521 | Chronic instability of right knee, anterior cruciate ligament | Use for chronic instability of the right knee due to previous ACL injury. |
|
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 tear
Essential facts and insights about Anterior Cruciate Ligament Injury
Primary ICD-10-CM Codes for anterior cruciate ligament
Decision Criteria
clinical Criteria
- Presence of acute knee trauma with positive Lachman test
Applicable To
- Acute ACL tear of right knee
Excludes
- Chronic instability of knee (M23.5-)
Clinical Validation Requirements
- Positive Lachman test with >5mm anterior translation
- MRI showing complete ACL fiber disruption
Code-Specific Risks
- Ensure laterality is documented to avoid unspecified coding.
Coding Notes
- Ensure to document the mechanism of injury and laterality.
M23.521 - Chronic instability of right knee, anterior cruciate ligament
Use for chronic instability of the right knee due to previous ACL injury.
Applicable To
- Chronic ACL insufficiency of right knee
Excludes
- Acute ACL tear (S83.5-)
Clinical Validation Requirements
- History of recurrent knee instability
- MRI showing attenuated ACL remnant
Coding Notes
Document the history of the injury and current instability.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Fall on same level from slipping, tripping and stumbling, initial encounter
W01.0XXADifferential 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 Injury to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S83.511A.
Impact
Clinical: Inadequate clinical understanding of injury context., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always include a detailed description of how the injury occurred., Use external cause codes to supplement the primary diagnosis.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Reduces the accuracy of clinical data.
Mitigation Strategy
Always document and code the specific side of the injury.
Impact
Coding without specifying the side of the injury.
Mitigation Strategy
Implement mandatory fields for laterality in EHR systems.
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 Injury, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Anterior Cruciate Ligament Injury
Use these documentation templates to ensure complete and accurate documentation for Anterior Cruciate Ligament Injury. These templates include all required elements for proper coding and billing.
Acute ACL Tear Documentation
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Physical exam findings
- Imaging results
- Surgical plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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