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ICD-10 Guide
DiagnosesAnterior Cruciate Ligament Repair

Anterior Cruciate Ligament Repair

ICD-10 Coding for Anterior Cruciate Ligament Repair(S83.511A, T84.410A)

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 Repair?
Essential facts and insights about Anterior Cruciate Ligament Repair

Key Clinical Considerations:

  • Patient presents with knee instability, pain, and swelling following an injury.
  • MRI findings indicating a complete tear of the anterior cruciate ligament (ACL).
  • Physical examination reveals a positive Lachman test or pivot shift test.
  • Imaging studies (MRI or X-ray) show joint effusion and ACL disruption.
  • Severity is often classified based on the degree of ligament damage (complete vs. partial tear).

Clinical Information

Clinical Criteria & Documentation Requirements

  • Medical records must include a detailed history of the injury and symptoms.
  • Specific terminology such as 'ACL tear' or 'ACL reconstruction' must be documented.
  • Examples include documenting the mechanism of injury and physical exam findings.
  • Medical necessity must be established through documentation of functional impairment.
  • Quality measures may include documentation of pre-operative assessments and post-operative outcomes.

Coding Guidelines

Usage Guidelines & Examples

  • Use S83.511A for a complete tear of the ACL in the right knee; T84.410A for complications following ACL repair.
  • Do not use these codes for partial tears or injuries to other ligaments.
  • Similar codes include S83.512A for the left knee ACL tear and S83.519A for unspecified knee ACL injuries.
  • Common errors include using the wrong laterality or failing to specify the type of tear.
  • In complex cases, ensure to document all relevant findings to support the selected code.

Code Exclusions

Important Exclusions

  • Excludes partial tears of the ACL (S83.512A) and injuries to other ligaments.
  • Alternative codes for excluded conditions include S83.519A for unspecified injuries.
  • Conditions are excluded to ensure accurate representation of the injury severity.
  • Common mistakes include misclassifying partial tears as complete tears.
  • Related conditions may include patellar tendon injuries or meniscal tears.

Related ICD-10 Codes

Primary Codes
S83.511A
Complete tear of anterior cruciate ligament of right knee, initial encounter
T84.410A
Infection following anterior cruciate ligament repair, initial encounter
Ancillary Codes
29877
Differential Codes
M23.5-
T84.5-

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Orthopedic Surgery

Specialty Applications

  • Applies to patients with ACL injuries, often due to sports or trauma.
  • Common in active individuals aged 15-35, with higher incidence in females.
  • Clinical settings include outpatient orthopedic clinics and inpatient surgical units.
  • Specialty-specific applications are primarily in orthopedic surgery and sports medicine.
  • Used in treatment contexts involving surgical repair or reconstruction of the ACL.

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 complete ACL tear based on MRI findings and physical examination.'

Template 2

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

Template 3

Template: 'Diagnostic criteria met as evidenced by MRI showing complete ACL disruption.'

Template 4

Template: 'Treatment plan initiated for ACL repair with arthroscopic intervention.'

Template 5

Template: 'Follow-up care for ACL reconstruction including monitoring of 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?

Documentation must include injury details, physical exam findings, and imaging results.

How does this differ from similar diagnoses?

Differentiation is based on the type of tear (complete vs. partial) and associated injuries.

What are common billing considerations?

Ensure accurate coding for the type of injury and any associated procedures to optimize 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 functional recovery metrics.