ICD-10 Coding for Acromioclavicular Joint Sprain(S43.50X, S43.51X, S43.52X)
Complete ICD-10-CM coding and documentation guide for Acromioclavicular Joint Sprain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Acromioclavicular Joint Sprain
S43.50-S43.52Primary Range
Sprain of acromioclavicular joint
This range covers the sprain of the acromioclavicular joint, including laterality and encounter type.
Dislocation of acromioclavicular joint
This range is used for dislocations, which are clinically distinct from sprains.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S43.50X | Sprain of unspecified acromioclavicular joint | Use when laterality is not documented. |
|
| S43.51X | Sprain of right acromioclavicular joint | Use when the sprain is confirmed on the right side. |
|
| S43.52X | Sprain of left acromioclavicular joint | Use when the sprain is confirmed on the left side. |
|
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 AC joint sprain
Essential facts and insights about Acromioclavicular Joint Sprain
Primary ICD-10-CM Codes for before meals joint sprain
Decision Criteria
documentation Criteria
- Laterality must be specified if known.
Applicable To
- Unspecified AC joint sprain
Excludes
- Dislocation of AC joint (S43.1-)
Clinical Validation Requirements
- Physical exam showing tenderness over AC joint
- X-ray ruling out dislocation
Code-Specific Risks
- May lead to lower reimbursement due to lack of specificity.
Coding Notes
- Ensure to document the mechanism of injury and symptoms.
S43.51X - Sprain of right acromioclavicular joint
Use when the sprain is confirmed on the right side.
Applicable To
- Right AC joint sprain
Excludes
- Dislocation of right AC joint (S43.11-)
Clinical Validation Requirements
- Positive cross-body adduction test
- X-ray confirming no dislocation
Coding Notes
Document the encounter type (initial, subsequent, sequela).
S43.52X - Sprain of left acromioclavicular joint
Use when the sprain is confirmed on the left side.
Applicable To
- Left AC joint sprain
Excludes
- Dislocation of left AC joint (S43.12-)
Clinical Validation Requirements
- Positive Paxinos test
- MRI showing no ligament rupture
Coding Notes
Ensure documentation includes mechanism of injury.
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.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Acromioclavicular Joint Sprain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S43.50X.
Impact
Clinical: Inaccurate tracking of patient progress., Regulatory: Non-compliance with ICD-10 guidelines., Financial: Potential claim denials.
Mitigation Strategy
Always include encounter type in documentation.
Impact
Reimbursement: May lead to reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of health records.
Mitigation Strategy
Ensure documentation specifies right or left AC joint.
Impact
Use of unspecified codes when laterality is known.
Mitigation Strategy
Educate providers on the importance of documenting 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 Acromioclavicular Joint Sprain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Acromioclavicular Joint Sprain
Use these documentation templates to ensure complete and accurate documentation for Acromioclavicular Joint Sprain. These templates include all required elements for proper coding and billing.
Emergency Department Visit for AC Joint Sprain
Specialty: Emergency MedicineRequired Elements
- Mechanism of injury
- Symptoms
- Physical exam findings
- Imaging results
- Assessment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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