ICD-10 Coding for Achilles Tendon Tear(S86.012A, M76.62)
Complete ICD-10-CM coding and documentation guide for Achilles Tendon Tear. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Achilles Tendon Tear
S86.0-S86.01Primary Range
Injury of Achilles tendon
This range covers traumatic injuries to the Achilles tendon, including ruptures and strains.
Achilles tendinitis
This range includes nontraumatic conditions affecting the Achilles tendon, such as tendinitis and spontaneous ruptures.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S86.012A | Strain of left Achilles tendon, initial encounter | Use for acute traumatic ruptures of the left Achilles tendon. |
|
| M76.62 | Achilles tendinitis, left leg | Use for chronic or nontraumatic conditions affecting the left Achilles tendon. |
|
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 tear
Essential facts and insights about Achilles Tendon Tear
Primary ICD-10-CM Codes for achilles tendon tear
Decision Criteria
clinical Criteria
- Sudden onset with a specific injury event
documentation Criteria
- Documentation must include laterality and mechanism of injury
Applicable To
- Acute traumatic rupture of left Achilles tendon
Excludes
- Nontraumatic rupture of Achilles tendon (M76.62)
Clinical Validation Requirements
- Mechanism of injury: sudden pop during activity
- Physical exam: palpable defect
- Positive Thompson test
Code-Specific Risks
- Confusion with nontraumatic codes
- Omission of laterality
Coding Notes
- Ensure documentation specifies the traumatic nature and laterality of the injury.
M76.62 - Achilles tendinitis, left leg
Use for chronic or nontraumatic conditions affecting the left Achilles tendon.
Applicable To
- Nontraumatic rupture of left Achilles tendon
Excludes
- Traumatic rupture of Achilles tendon (S86.012A)
Clinical Validation Requirements
- No acute injury reported
- History of tendinopathy
- Spontaneous rupture during normal activity
Coding Notes
Ensure documentation distinguishes between traumatic and nontraumatic causes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Open wound of lower leg
S81.-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 Achilles Tendon Tear to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S86.012A.
Impact
Clinical: Ambiguity in treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Always document the affected side, Use templates that prompt for laterality
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use M76.6- codes for nontraumatic or chronic conditions.
Impact
Misclassification of Achilles tendon injuries can lead to audits.
Mitigation Strategy
Ensure documentation clearly differentiates traumatic from nontraumatic causes.
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 Tear, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Achilles Tendon Tear
Use these documentation templates to ensure complete and accurate documentation for Achilles Tendon Tear. These templates include all required elements for proper coding and billing.
Acute Achilles Rupture
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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