ICD-10 Coding for ACL Rupture(S83.511A, S83.512A)
Complete ICD-10-CM coding and documentation guide for ACL Rupture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to ACL 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 |
|---|---|---|---|
| S83.511A | Sprain of anterior cruciate ligament of right knee, initial encounter | Use for initial encounter of an acute ACL rupture in the right knee. |
|
| S83.512A | Sprain of anterior cruciate ligament of left knee, initial encounter | Use for initial encounter of an acute ACL rupture in 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 rupture
Essential facts and insights about ACL Rupture
Primary ICD-10-CM Codes for anterior cruciate ligament rupture
Decision Criteria
clinical Criteria
- Confirmed ACL rupture via MRI
documentation Criteria
- Documented mechanism of injury
Applicable To
- Acute ACL tear of right knee
Excludes
- Chronic instability of knee (M23.5)
Clinical Validation Requirements
- MRI confirmation of ACL rupture
- Positive Lachman test
Code-Specific Risks
- Ensure laterality is specified
- Include mechanism of injury
Coding Notes
- Ensure to document the mechanism of injury and confirm the diagnosis with imaging.
S83.512A - Sprain of anterior cruciate ligament of left knee, initial encounter
Use for initial encounter of an acute ACL rupture in the left knee.
Applicable To
- Acute ACL tear of left knee
Excludes
- Chronic instability of knee (M23.5)
Clinical Validation Requirements
- MRI confirmation of ACL rupture
- Positive Lachman test
Coding Notes
Ensure to document the mechanism of injury and confirm the diagnosis with imaging.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting ACL Rupture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S83.511A.
Impact
Clinical: Inadequate clinical picture for treatment planning., Regulatory: Potential non-compliance with coding standards., Financial: Risk of claim denial due to incomplete documentation.
Mitigation Strategy
Always document how the injury occurred., Use external cause codes appropriately.
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with ICD-10 coding standards., Data Quality: Inaccurate patient records and data reporting.
Mitigation Strategy
Always document whether the injury is to the right or left knee.
Impact
Lack of detailed clinical notes can lead to audit issues.
Mitigation Strategy
Ensure all required elements are documented, including laterality and mechanism of injury.
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 Rupture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for ACL Rupture
Use these documentation templates to ensure complete and accurate documentation for ACL Rupture. These templates include all required elements for proper coding and billing.
Acute ACL rupture during sports
Specialty: OrthopedicsRequired 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
Need help with ICD-10 coding for ACL Rupture? Ask your questions below.