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ICD-10 Coding for Right Knee ACL Tear(S83.511A, M23.511)

Complete ICD-10-CM coding and documentation guide for Right Knee ACL Tear. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Right ACL InjuryRight Anterior Cruciate Ligament Tear

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Related ICD-10 Code Ranges

Complete code families applicable to Right Knee ACL Tear

S83.5-S83.6Primary Range

Injury of ligaments of knee

This range includes codes for sprains and tears of the knee ligaments, including the ACL.

M23.5

Chronic instability of knee

Used for chronic conditions resulting from old ACL injuries.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
S83.511ASprain of anterior cruciate ligament of right knee, initial encounterFor acute ACL injuries of the right knee, typically within 6 months of injury.
  • MRI confirmation of ACL tear
  • Positive Lachman test
  • Acute injury mechanism
M23.511Chronic instability of right kneeFor chronic conditions resulting from an old ACL tear.
  • Symptoms persisting beyond 6 months
  • Recurrent knee instability

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 right knee ACL tear

Essential facts and insights about Right Knee ACL Tear

The ICD-10 code for an acute right knee ACL tear is S83.511A, while chronic instability is coded as M23.511.

Primary ICD-10-CM Codes for right knee acl tear

S83.511A
Sprain of anterior cruciate ligament of right knee, initial encounter
Billable Code

Decision Criteria

clinical Criteria

  • Acute injury with MRI confirmation

documentation Criteria

  • Documented as 'tear' or 'sprain', not 'disruption'

Applicable To

  • Acute ACL tear of right knee

Excludes

  • Chronic instability of knee (M23.5-)

Clinical Validation Requirements

  • MRI confirmation of ACL tear
  • Positive Lachman test
  • Acute injury mechanism

Code-Specific Risks

  • Misclassification as a dislocation if 'disruption' is used in documentation.

Coding Notes

  • Ensure laterality and acuteness are documented.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Activity, soccer

Y93.64
Use to specify the activity during which the injury occurred.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Chronic instability of right knee

M23.511
Used when the injury is chronic, typically more than 6 months post-injury.

Sprain of anterior cruciate ligament of right knee, initial encounter

S83.511A
Used for acute injuries within 6 months.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Right Knee 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 misdiagnosis or inappropriate treatment., Regulatory: Could result in non-compliance with coding standards., Financial: Potential for denied claims due to insufficient documentation.

Mitigation Strategy

Always include a detailed description of how the injury occurred., Use templates to ensure all elements are covered.

Impact

Reimbursement: May lead to incorrect DRG assignment., Compliance: Could result in audit discrepancies., Data Quality: Affects accuracy of clinical data.

Mitigation Strategy

Clarify with the provider to ensure correct terminology is used.

Impact

Using acute codes for chronic conditions can lead to audits.

Mitigation Strategy

Ensure clear documentation of the timeline of symptoms.

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 Right Knee ACL Tear, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Right Knee ACL Tear

Use these documentation templates to ensure complete and accurate documentation for Right Knee ACL Tear. These templates include all required elements for proper coding and billing.

Acute ACL tear in a soccer player

Specialty: Orthopedics

Required Elements

  • Mechanism of injury
  • Physical exam findings
  • Imaging results
  • Treatment plan

Example Documentation

Patient presents with right knee pain after a soccer injury. Lachman test positive with 10mm translation. MRI confirms complete ACL tear. Plan for arthroscopic reconstruction.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has knee injury.
Good Documentation Example
Patient presents with acute right knee ACL tear confirmed by MRI, following a soccer injury.
Explanation
The good example provides specific details on the injury, laterality, and confirmation method.

Need help with ICD-10 coding for Right Knee ACL Tear? Ask your questions below.

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