ICD-10 Coding for ACL Tear(S83.511A, S83.512A)
Complete ICD-10-CM coding and documentation guide for ACL Tear. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to ACL Tear
S83.51-S83.52Primary Range
Sprain and strain of knee ligaments
This range includes codes for ACL tears, specifying laterality and encounter type.
Chronic instability of knee
Used for chronic ACL insufficiency or old tears without recent trauma.
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 acute traumatic tears of the right ACL during the initial encounter. |
|
| S83.512A | Sprain of anterior cruciate ligament of left knee, initial encounter | Use for acute traumatic tears of the left ACL during the initial encounter. |
|
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 ACL Tear
Primary ICD-10-CM Codes for acl tear
Decision Criteria
clinical Criteria
- MRI shows complete ACL tear
documentation Criteria
- Documentation specifies 'acute tear' and laterality
Applicable To
- Acute ACL tear of right knee
Excludes
- Chronic ACL insufficiency (M23.51)
Clinical Validation Requirements
- MRI confirmation of ACL tear
- Positive Lachman test
Code-Specific Risks
- Incorrect laterality
- Missing 7th character
Coding Notes
- Ensure documentation specifies 'tear' or 'sprain' to avoid incorrect coding as dislocation.
S83.512A - Sprain of anterior cruciate ligament of left knee, initial encounter
Use for acute traumatic tears of the left ACL during the initial encounter.
Applicable To
- Acute ACL tear of left knee
Excludes
- Chronic ACL insufficiency (M23.52)
Clinical Validation Requirements
- MRI confirmation of ACL tear
- Positive Lachman test
Coding Notes
Ensure documentation specifies 'tear' or 'sprain' to avoid incorrect coding as dislocation.
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.
Dislocation of knee
S83.18Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting ACL Tear to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S83.511A.
Impact
Clinical: May lead to incorrect diagnosis and treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials or reduced reimbursement.
Mitigation Strategy
Use specific terms like 'tear' or 'sprain', Document diagnostic findings clearly
Impact
Reimbursement: May lead to claim denials or incorrect payments., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Verify laterality in documentation before coding.
Impact
Reimbursement: Claims may be rejected for incomplete coding., Compliance: Failure to meet ICD-10 coding standards., Data Quality: Incomplete clinical documentation.
Mitigation Strategy
Ensure the 7th character is included to indicate the encounter type.
Impact
Potential for coding ACL tears as dislocations due to ambiguous documentation.
Mitigation Strategy
Ensure clear documentation of 'tear' or 'sprain' and confirm with imaging.
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, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for ACL Tear
Use these documentation templates to ensure complete and accurate documentation for ACL Tear. These templates include all required elements for proper coding and billing.
Initial evaluation of suspected ACL tear
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Physical examination findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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