Two Common Knee Ligament Injuries and Their ICD-10 Codes

by | Published on Feb 15, 2021 | Medical Coding

Knee Ligament Injuries
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Knee ligaments connect the bones and cartilage, and hold and support the knee joint. Any mild tear in ligaments may severely limit the movement of the knees. Most commonly occurring from a sports injury, ligament damage may severely limit the movement of the knees and make it more unstable. This in turn may result in the ability to pivot, turn or twist the leg. Ligament injuries, in most cases, occur due to a blow to the outer side of the knee (most commonly during sports activities like when playing hockey or football). A loud knee pop and buckle, causing severe pain and swelling is one of the key symptoms associated with the condition. The signs and symptoms may vary and depend on the type and severity of injury. Treatment modalities for knee ligament injuries may depend on a wide range of factors like the age of the patient, type and severity of injury and overall health and medical history of the patient. Early diagnosis and appropriate treatment are essential to get better outcomes, or else knee injuries can result in pain, swelling and loss of function. Billing and coding for different types of knee ligament injuries can be challenging. Using the right medical codes to document the symptoms, diagnosis and treatment of these types of injuries is crucial for accurate processing of medical claims. For correct clinical documentation, physicians can outsource medical billing and coding tasks to a reliable medical billing company.

Here discussed are two common knee ligament injuries and their related ICD-10 codes –

Anterior Cruciate Ligament (ACL) – ACL refers to a tear or sprain of the anterior cruciate ligament (ACL). One of the key ligaments in the knee joint, the ACL connects the bottom of the thighbone (femur) to the top of the shinbone (tibia) that helps stabilize your knee joint. This type of injury most commonly occurs during sports activities (involving sudden stops or changes in direction, jumping and landing) like – soccer, basketball, football and downhill skiing – that can put additional stress on the knee. A loud “pop” or a “popping” sensation in the knee is one of the key symptoms associated with the condition. Other symptoms include – loss of full range of motion, rapid swelling and tenderness along the joint line, discomfort while walking and severe pain and inability to continue activity. Diagnosis of this condition begins with a physical examination wherein they will be examining all the structures of the injured knee. Imaging tests like X-ray and magnetic resonance imaging (MRI) will also be performed to confirm the diagnosis. Treatment for an ACL tear will vary depending on the severity of the injury and may include rest, bracing, physical therapy, and other rehabilitation exercises that help regain strength and stability. In severe cases, surgery will be performed to rebuild an anterior cruciate ligament. ICD-10 diagnosis codes for ACL injuries include –

  • S83.51 Sprain of anterior cruciate ligament of knee
  • S83.511 Sprain of anterior cruciate ligament of right knee
    • S83.511A …… initial encounter
    • S83.511D …… subsequent encounter
    • S83.511S …… sequela
  • S83.512 Sprain of anterior cruciate ligament of left knee
    • S83.512A …… initial encounter
    • S83.512D …… subsequent encounter
    • S83.512S …… sequela
  • S83.519 Sprain of anterior cruciate ligament of unspecified knee
    • S83.519A …… initial encounter
    • S83.519D …… subsequent encounter
    • S83.519S …… sequela

Posterior Cruciate Ligament (PCL) – Located in the back of the knee, the posterior cruciate ligament (PCL) connects the femur (thighbone) to the tibia (shinbone) and keeps the tibia from moving backwards too far. The posterior cruciate ligament could be injured if the shinbone is hit hard below the knee or if you fall on a bent knee. Any minor tear in the ligament may cause severe pain, swelling and a feeling of instability. These types of injuries are most common during motor vehicle incidents and involvement in contact sports such as football and soccer. Pain, swelling and instability are the most common symptoms associated with the condition. These symptoms can be mild in the beginning stage; however, as the condition advances, it worsens and causes instability in the knees. Initial diagnosis may begin with a physical exam wherein the physician may press or examine the knees to feel for injury, looseness or fluid in the joint from bleeding. They may check the movement of the knees, leg or foot in different directions. Imaging tests like X-ray and MRI scan and arthroscopy (using a surgical technique) are usually performed to examine the knee joint. Treatment depends on the extent and severity of the injury. Common treatment modalities include – medications (over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium) and physical therapy. On the other hand, if the injury is severe (particularly it is combined with other torn knee ligaments) – surgery may be required to reconstruct the ligament. Surgery may be performed arthroscopically by inserting a fiber-optic camera and other surgical tools through small incisions around the knee. Related ICD-10 codes include –

  • S83.52 Sprain of posterior cruciate ligament of knee
  • S83.521 Sprain of posterior cruciate ligament of right knee
    • S83.521A …… initial encounter
    • S83.521D …… subsequent encounter
    • S83.521S …… sequela
  • S83.522 Sprain of posterior cruciate ligament of left knee
    • S83.522A …… initial encounter
    • S83.522D …… subsequent encounter
    • S83.522S …… sequela
  • S83.529 Sprain of posterior cruciate ligament of unspecified knee
    • S83.529A …… initial encounter
    • S83.529D …… subsequent encounter
    • S83.529S …… sequela

A mild to moderate knee ligament injury may heal on its own, in time. To speed up healing, it is important to rest the knee; icing the knees, compressing the knees (wearing an elastic bandage, straps, braces or sleeves on your knee to control swelling) and practicing strengthening and stretching exercises can also help speed up the recovery process.

Billing and coding for knee ligament injuries can be complex, as there are different codes associated with each specific condition. By utilizing outsourced medical coding services provided by AAPC-certified coding specialists, healthcare practices can ensure accurate and timely medical billing and claims submission.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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