ICD-10 Coding for Tear of ACL(S83.511A, S83.512A)
Complete ICD-10-CM coding and documentation guide for Tear of ACL. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Tear of ACL
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. |
|
| S83.512A | Sprain of anterior cruciate ligament of left knee, initial encounter | Use for initial encounter of acute ACL tear in the left knee. |
|
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 Tear of ACL
Primary ICD-10-CM Codes for tear of acl
Decision Criteria
clinical Criteria
- MRI shows fiber discontinuity
documentation Criteria
- Documented mechanism of injury
Applicable To
- Acute tear of ACL, right knee
Excludes
- Chronic instability of knee (M23.5-)
Clinical Validation Requirements
- MRI confirmation of fiber discontinuity
- Positive Lachman test with >5mm translation
Code-Specific Risks
- Ensure laterality is documented
- Confirm acute nature of injury
Coding Notes
- Ensure documentation includes mechanism of injury and confirmatory tests.
S83.512A - Sprain of anterior cruciate ligament of left knee, initial encounter
Use for initial encounter of acute ACL tear in the left knee.
Applicable To
- Acute tear of ACL, left knee
Excludes
- Chronic instability of knee (M23.5-)
Clinical Validation Requirements
- MRI confirmation of fiber discontinuity
- Positive Lachman test with >5mm translation
Coding Notes
Ensure documentation includes mechanism of injury and confirmatory tests.
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.
Chronic instability of knee
M23.51Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Tear of ACL 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 evidence for diagnosis, Regulatory: Potential audit trigger, Financial: Claim denials due to insufficient documentation
Mitigation Strategy
Always include MRI results in the patient's record, Ensure radiologist's report is attached
Impact
Reimbursement: Incorrect DRG assignment leading to potential underpayment., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Misclassification of injury type in medical records.
Mitigation Strategy
Use S83.51- codes for acute injuries.
Impact
Reimbursement: Claims may be denied or delayed., Compliance: Inaccurate coding can lead to audits., Data Quality: Incomplete data for clinical analysis.
Mitigation Strategy
Ensure laterality is specified in the medical record.
Impact
Failure to specify laterality can lead to audit findings.
Mitigation Strategy
Implement checklist for documentation completeness.
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 Tear of ACL, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Tear of ACL
Use these documentation templates to ensure complete and accurate documentation for Tear of ACL. These templates include all required elements for proper coding and billing.
Initial evaluation of ACL tear
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Physical exam findings
- MRI results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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