ICD-10 Coding for ACL Tear Right Knee(S83.511A, S83.511D, S83.511S)
Complete ICD-10-CM coding and documentation guide for ACL Tear Right Knee. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to ACL Tear Right Knee
S83.5Primary Range
Sprain and strain of joints and ligaments of knee
This range includes specific codes for ACL tears, including laterality and encounter type.
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 an acute ACL tear of the right knee. |
|
| S83.511D | Sprain of anterior cruciate ligament of right knee, subsequent encounter | Use for follow-up encounters after initial treatment of an ACL tear. |
|
| S83.511S | Sprain of anterior cruciate ligament of right knee, sequela | Use for chronic conditions resulting from an ACL tear. |
|
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 right knee
Essential facts and insights about ACL Tear Right Knee
Primary ICD-10-CM Codes for acl tear right knee
Decision Criteria
clinical Criteria
- MRI shows midsubstance ACL fiber discontinuity
documentation Criteria
- Documentation specifies right knee and initial encounter
Applicable To
- Acute complete tear of right ACL
Excludes
- Sprain of anterior cruciate ligament of left knee (S83.512A)
Clinical Validation Requirements
- MRI showing midsubstance ACL fiber discontinuity
- Positive Lachman test
Code-Specific Risks
- Missing 7th character
- Incorrect laterality
Coding Notes
- Ensure documentation specifies laterality and encounter type.
S83.511D - Sprain of anterior cruciate ligament of right knee, subsequent encounter
Use for follow-up encounters after initial treatment of an ACL tear.
Applicable To
- Follow-up for ACL reconstruction
Excludes
- Initial encounter for ACL tear (S83.511A)
Clinical Validation Requirements
- Post-surgical follow-up notes
- Physical therapy progress
Coding Notes
Ensure encounter type is documented as subsequent.
S83.511S - Sprain of anterior cruciate ligament of right knee, sequela
Use for chronic conditions resulting from an ACL tear.
Applicable To
- Chronic ACL deficiency with instability
Excludes
- Acute ACL tear (S83.511A)
Clinical Validation Requirements
- Persistent knee instability
- Chronic pain or dysfunction
Coding Notes
Ensure documentation reflects chronic sequelae.
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 without subsequent striking against object, initial encounter
W01.0XXADifferential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Sprain of anterior cruciate ligament of left knee, initial encounter
S83.512ADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting ACL Tear Right Knee to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S83.511A.
Impact
Clinical: Incomplete clinical picture of the injury, Regulatory: Non-compliance with coding guidelines, Financial: Potential claim denials
Mitigation Strategy
Always document the mechanism of injury, Include relevant external cause codes
Impact
Reimbursement: Claims may be denied or delayed., Compliance: Non-compliance with coding standards., Data Quality: Inaccurate clinical data reporting.
Mitigation Strategy
Ensure the 7th character is included to specify encounter type.
Impact
Missing details such as laterality or encounter type can lead to audits.
Mitigation Strategy
Ensure all required documentation elements are included.
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 ACL Tear Right Knee, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for ACL Tear Right Knee
Use these documentation templates to ensure complete and accurate documentation for ACL Tear Right Knee. 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
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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