ICD-10 Coding for MCL Tear(S83.432A, M23.361)
Complete ICD-10-CM coding and documentation guide for MCL Tear. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to MCL Tear
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S83.432A | Tear of medial collateral ligament of left knee, initial encounter | Use for initial encounter of a complete MCL tear with confirmed imaging and clinical findings. |
|
| M23.361 | Other spontaneous disruption of ligaments of left knee | Use for chronic instability following an MCL 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 MCL tear
Essential facts and insights about MCL Tear
Primary ICD-10-CM Codes for mcl tear
Decision Criteria
clinical Criteria
- MRI shows complete fiber disruption
documentation Criteria
- Documentation specifies 'complete tear' and laterality
Applicable To
- Complete tear of MCL
- Grade III MCL tear
Excludes
- Sprain of MCL (S83.412A)
Clinical Validation Requirements
- Valgus stress test showing >10mm joint space opening
- MRI confirmation of complete fiber disruption
Code-Specific Risks
- Confusion with sprain codes
- Incorrect laterality
Coding Notes
- Ensure documentation specifies complete tear and laterality.
M23.361 - Other spontaneous disruption of ligaments of left knee
Use for chronic instability following an MCL tear.
Applicable To
- Chronic instability post MCL tear
Excludes
- Acute MCL tear (S83.432A)
Clinical Validation Requirements
- Recurrent knee instability
- Laxity on physical exam
Coding Notes
Document chronic symptoms and history of MCL tear.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for other orthopedic aftercare
Z47.89Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Sprain of medial collateral ligament of left knee, initial encounter
S83.412ADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting MCL Tear to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S83.432A.
Impact
Clinical: May lead to incorrect treatment planning., Regulatory: Non-compliance with ICD-10 coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always document left or right knee.
Impact
Reimbursement: Incorrect coding can lead to denied claims or incorrect reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Impacts accuracy of clinical data.
Mitigation Strategy
Clarify with provider if documentation is unclear whether it's a sprain or tear.
Impact
Using 'A' for encounters beyond active treatment phase.
Mitigation Strategy
Review encounter type guidelines regularly.
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 MCL Tear, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for MCL Tear
Use these documentation templates to ensure complete and accurate documentation for MCL Tear. These templates include all required elements for proper coding and billing.
Orthopedic evaluation of MCL tear
Specialty: OrthopedicsRequired Elements
- Laterality
- Tear grade
- Valgus stress test results
- MRI findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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