ICD-10 Coding for Achilles Tendon Rupture(S86.011A, S86.012A, S86.019A)
Complete ICD-10-CM coding and documentation guide for Achilles Tendon Rupture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Achilles Tendon Rupture
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S86.011A | Strain of right Achilles tendon, initial encounter | Use for initial encounter of traumatic rupture of the right Achilles tendon. |
|
| S86.012A | Strain of left Achilles tendon, initial encounter | Use for initial encounter of traumatic rupture of the left Achilles tendon. |
|
| S86.019A | Strain of unspecified Achilles tendon, initial encounter | Use when laterality is not specified in the 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 Achilles tendon rupture
Essential facts and insights about Achilles Tendon Rupture
Primary ICD-10-CM Codes for achilles tendon rupture
Decision Criteria
clinical Criteria
- Presence of a palpable gap and positive Thompson test
Applicable To
- Acute traumatic rupture of right Achilles tendon
Excludes
- Spontaneous rupture of right Achilles tendon (M66.31)
Clinical Validation Requirements
- Positive Thompson test
- MRI confirmation of rupture
Code-Specific Risks
- Ensure laterality is documented to avoid unspecified coding.
Coding Notes
- Ensure documentation specifies traumatic nature and laterality.
S86.012A - Strain of left Achilles tendon, initial encounter
Use for initial encounter of traumatic rupture of the left Achilles tendon.
Applicable To
- Acute traumatic rupture of left Achilles tendon
Excludes
- Spontaneous rupture of left Achilles tendon (M66.32)
Clinical Validation Requirements
- Positive Thompson test
- MRI confirmation of rupture
Coding Notes
Ensure documentation specifies traumatic nature and laterality.
S86.019A - Strain of unspecified Achilles tendon, initial encounter
Use when laterality is not specified in the documentation.
Applicable To
- Acute traumatic rupture of unspecified Achilles tendon
Excludes
- Spontaneous rupture of unspecified Achilles tendon (M66.39)
Clinical Validation Requirements
- Positive Thompson test
- MRI confirmation of rupture
Coding Notes
Ensure documentation specifies traumatic nature.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
MRI of ankle
73721Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Strain of muscle and tendon of the posterior muscle group at lower leg level
S86.21XADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Achilles Tendon Rupture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S86.011A.
Impact
Clinical: Inadequate clinical picture for treatment planning., Regulatory: Potential for audit issues., Financial: Risk of claim denial due to insufficient documentation.
Mitigation Strategy
Always document how the injury occurred., Include patient statements about the event.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data reporting.
Mitigation Strategy
Reserve M66.3- for spontaneous ruptures only.
Impact
Using unspecified codes when laterality is not documented.
Mitigation Strategy
Implement mandatory fields in EHR for laterality.
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 Achilles Tendon Rupture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Achilles Tendon Rupture
Use these documentation templates to ensure complete and accurate documentation for Achilles Tendon Rupture. These templates include all required elements for proper coding and billing.
Acute Achilles Tendon Rupture in Emergency Department
Specialty: Emergency MedicineRequired Elements
- 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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