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ICD-10 Guide
DiagnosesAnterior Cruciate Ligament Reconstruction

Anterior Cruciate Ligament Reconstruction

ICD-10 Coding for Anterior Cruciate Ligament Reconstruction(S83.53-, M23.5-)

PRIMARY SPECIALTYOrthopedic Surgery
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Anterior Cruciate Ligament Reconstruction?
Essential facts and insights about Anterior Cruciate Ligament Reconstruction

Key Clinical Considerations:

  • Patient presents with knee instability, often described as a 'giving way' sensation during physical activity.
  • Positive Lachman test or anterior drawer test indicating anterior cruciate ligament (ACL) injury.
  • Swelling and pain in the knee joint, particularly after physical activity or injury.
  • Imaging findings from MRI showing ACL tear or rupture.
  • Severity of injury classified as partial or complete tear based on clinical and imaging findings.

Clinical Information

Clinical Criteria & Documentation Requirements

  • Complete medical history including mechanism of injury and symptom onset.
  • Specific terminology such as 'anterior cruciate ligament tear' or 'ACL reconstruction' must be documented.
  • Examples include: 'Patient diagnosed with complete ACL tear based on MRI findings.'
  • Documentation must support medical necessity for surgical intervention, including failed conservative management.
  • Quality measures may include documentation of pre-operative assessments and post-operative outcomes.

Coding Guidelines

Usage Guidelines & Examples

  • Use S83.53- for complete ACL tears and M23.5- for other specified disorders of the ACL.
  • Do NOT use these codes for conditions like meniscal tears or collateral ligament injuries unless specified.
  • Comparison with codes like S83.51- (partial tear) and M23.4- (meniscal tears) for accurate coding.
  • Common errors include using the wrong specificity level; ensure the documentation matches the code's specificity.
  • In complex cases, consider the patient's entire clinical picture and any co-existing conditions.

Code Exclusions

Important Exclusions

  • Excludes conditions like meniscal tears (M23.2-) and collateral ligament injuries (S83.4-).
  • Alternative codes for excluded conditions include S83.52- for sprains of the ACL.
  • Conditions are excluded to ensure specificity in coding and appropriate treatment pathways.
  • Common mistakes include misclassifying ACL injuries with meniscal injuries; ensure accurate documentation.
  • Related but distinct conditions include patellar tendon injuries and other knee ligament injuries.

Related ICD-10 Codes

Primary Codes
S83.53
Complete tear of anterior cruciate ligament of knee
M23.5
Other specified disorders of the anterior cruciate ligament
Ancillary Codes
20924
29888
Differential Codes
M23.5-
S83.53-

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Orthopedic Surgery

Specialty Applications

  • Primarily applies to patients with ACL injuries, often athletes or active individuals.
  • Patient populations include young adults and middle-aged individuals, particularly those involved in sports.
  • Clinical settings include outpatient orthopedic clinics and inpatient surgical facilities.
  • Specialty-specific applications are relevant in orthopedic surgery and sports medicine.
  • Treatment contexts include post-injury surgical intervention and rehabilitation protocols.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Template 1

Template: 'Patient diagnosed with ACL tear based on MRI findings and clinical assessment.'

Template 2

Template: 'Clinical presentation consistent with ACL injury including knee instability and swelling.'

Template 3

Template: 'Diagnostic criteria met as evidenced by positive Lachman test and MRI confirmation.'

Template 4

Template: 'Treatment plan initiated for ACL reconstruction with pre-operative rehabilitation outlined.'

Template 5

Template: 'Follow-up care for ACL reconstruction including monitoring for range of motion and strength.'

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

What documentation is required for this diagnosis?

Detailed documentation of injury mechanism, clinical findings, and imaging results.

How does this differ from similar diagnoses?

ACL injuries are specifically related to the anterior ligament, while meniscal injuries involve cartilage.

What are common billing considerations?

Ensure that the procedure is medically necessary and supported by documentation for optimal reimbursement.

What procedures are typically associated?

Commonly associated CPT codes include 29888 for arthroscopic ACL reconstruction.

Are there any quality reporting implications?

Quality measures may include tracking post-operative outcomes and patient satisfaction scores.