ICD-10 Coding for Tear of the ACL(S83.511A, S83.512A)
Complete ICD-10-CM coding and documentation guide for Tear of the 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 the 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 | Tear of anterior cruciate ligament of right knee, initial encounter | Use for initial encounters of acute ACL tears on the right knee. |
|
| S83.512A | Tear of anterior cruciate ligament of left knee, initial encounter | Use for initial encounters of acute ACL tears on 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 the ACL
Primary ICD-10-CM Codes for tear of the acl
Decision Criteria
clinical Criteria
- MRI shows fiber discontinuity
documentation Criteria
- Documentation specifies 'complete rupture' and laterality
Applicable To
- Acute tear of right ACL
Excludes
- Chronic instability of knee (M23.5-)
Clinical Validation Requirements
- MRI confirmation of fiber discontinuity
- Positive Lachman test with >5mm anterior translation
Code-Specific Risks
- Incorrect laterality documentation
- Missing encounter type
Coding Notes
- Ensure documentation specifies laterality and encounter type.
S83.512A - Tear of anterior cruciate ligament of left knee, initial encounter
Use for initial encounters of acute ACL tears on the left knee.
Applicable To
- Acute tear of left ACL
Excludes
- Chronic instability of knee (M23.5-)
Clinical Validation Requirements
- MRI confirmation of fiber discontinuity
- Positive Lachman test with >5mm anterior translation
Coding Notes
Ensure documentation specifies laterality and encounter type.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Fall on same level, initial encounter
W01.0XXADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Tear of the 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: Inaccurate treatment records., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always include encounter type in documentation., Use templates that prompt for encounter details.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Use S83.51- for acute ACL tears.
Impact
Missing encounter type can lead to audits.
Mitigation Strategy
Use structured templates to ensure complete 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 Tear of the ACL, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Tear of the ACL
Use these documentation templates to ensure complete and accurate documentation for Tear of the ACL. These templates include all required elements for proper coding and billing.
Initial encounter for ACL tear
Specialty: OrthopedicsRequired Elements
- Patient history
- Mechanism of injury
- Physical exam findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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