Orthopedic Coding Alert

Find out if all injuries require surgery.

When the weather gets cold, winter sports enthusiasts strap on their skis or snowboards or lace up their skates and hit the slopes or the rink, but these popular sports carry a significant risk of injury. While activities like skiing, snowboarding, and ice skating are lots of fun, they can lead to a variety of injuries, often involving the knees, wrists, and shoulders.

Read on to learn about common winter sports injuries and how to report the treatments.

Check Out These Common Winter Sports Injuries

According to the American Academy of Orthopaedic Surgeons, nearly 200,000 winter sports enthusiasts are treated for injuries in emergency rooms and clinics nationwide. The most frequent injuries include sprains, strains, fractures, and dislocations. Here’s a look at some common winter activities and their associated injuries:

Skiing Injuries

• Knee injuries are the most common injury in skiing, often resulting from twisting motions and sudden stops or falls. Anterior cruciate ligament (ACL) and meniscal tears are particularly prevalent and can take months to heal or may require surgery.
• Skier’s thumb is a tear of the ulnar collateral ligament (UCL) in the thumb, which is caused by falling while holding a ski pole.

Snowboarding Injuries

• Wrist fractures are the most common injury for snowboarders, with many incidents occurring from backward falls as beginners instinctively try to break their fall with an outstretched hand.
• Ankle injuries, such as sprains and fractures, are also prevalent, especially for beginners.

Ice Skating Injuries

• Fractures are the most common skating injury, particularly involving the wrist and upper arm from falls.
• Acute ligament tears can occur from landing a jump or slipping awkwardly.

Understand the Treatment Process

Orthopedic surgeons treat winter sports injuries using a tiered approach that combines nonsurgical methods and advanced surgical techniques, often followed by comprehensive rehabilitation. The specific treatment depends on the type and severity of the injury with the overall goal to restore function and get athletes back to their sport.

Initial management: An initial assessment by an orthopedic surgeon in the clinic setting involves an evaluation and management (E/M) service and likely X-rays. Depending on the type and severity of injury, the provider may also order an MRI.

Code Nonsurgical Injuries

Not all winter sports injuries require surgery. For injuries like nondisplaced fractures, minor sprains, and contusions, the orthopedic specialists may recommend one of the following treatments:

• Immobilization: The physician applies a cast, splint, or brace that can stabilize fractures or severe sprains, giving the injury time to heal properly.
• Injections: In some cases, the orthopedist may administer injections to reduce pain and inflammation.
• Physical therapy: This is a crucial component of recovery, helping patients regain strength, flexibility, and stability without an operation.

Examine These Nonsurgical Coding Scenarios

Scenario 1: A patient suffers a fall while ice skating, landing on their left shoulder. The orthopedic surgeon evaluates the new patient in the office, takes and interprets two left shoulder X-ray views, and diagnoses the patient with a left shoulder contusion.

• CPT^® codes: Assign an appropriate new patient E/M code, such as 99202-99203 (Office or other outpatient visit for the evaluation and management of a new patient …). You’ll also use 73030 (Radiologic examination, shoulder; complete, minimum of 2 views) appended with modifier LT (Left side) to report the X-rays of the left shoulder.
• ICD-10-CM codes: Use S40.012A (Contusion of left shoulder, initial encounter) to report the documented diagnosis of a left shoulder contusion. You’ll then assign V00.211A (Fall from ice-skates, initial encounter) to report how the injury occurred.

Scenario 2: A 22-year-old snowboarder collides with another snowboarder and suffers a twisting injury to the right ankle. The orthopedic surgeon evaluates the new patient in the office, captures three X-ray views of the right ankle, and diagnoses the patient with a mild right ankle sprain. The doctor recommends conservative management with rest, ice, compression, and elevation.

• CPT^® codes: Use an appropriate new patient E/M code, such as 99202 or 99203, as well as 73610 (Radiologic examination, ankle; complete, minimum of 3 views) appended with modifier RT (Right side) to report the X-rays of the right ankle.

• ICD-10-CM codes: Assign S93.401A (Sprain of unspecified ligament of right ankle, initial encounter) to report the documented right ankle sprain diagnosis. Plus, use V00.318A (Other snowboard accident, initial encounter) to show how the injury occurred.

Understand When Surgery Is Needed

Some winter sports injuries require surgery. For injuries like displaced fractures and ACL tears, the orthopedic specialist may recommend:

• ACL reconstruction: An orthopedic surgeon replaces the torn ACL with a tissue graft, typically from the patient's own body (an autograft) or a deceased donor (an allograft). This is often done arthroscopically, which is a minimally invasive technique that uses a tiny camera and instruments inserted through small incisions.
• Fracture repair: Complex or displaced fractures may require surgery where the surgeon realigns the bone fragments and secures them with plates, screws, or pins.

Try Your Hand at These Surgical Coding Scenarios

Scenario 1: A 24-year-old downhill ski racer suffered a fall and sustained a complete rupture of their right knee ACL and a peripheral tear of their lateral meniscus. The surgeon performed an arthroscopic-assisted ACL reconstruction and arthroscopic lateral meniscus repair.

• CPT^® codes: Use 29888 (Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction) appended with modifier RT to report the arthroscopic-assisted ACL reconstruction. Assign 29882 (Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral)) to report the lateral meniscus repair. You’ll also append modifiers 51 (Multiple procedures) and RT to 29882 to indicate that the meniscus repair was performed in addition to the ACL reconstruction.

• ICD-10-CM codes: Assign S83.511A (Sprain of anterior cruciate ligament of right knee, initial encounter) and S83.261A (Peripheral tear of lateral meniscus, current injury, right knee, initial encounter) to report the ACL sprain and lateral meniscus tear of the right knee, respectively.

Scenario 2: A 52-year-old patient fell while ice skating and sustained a displaced intra-articular fracture of their left distal radius. The orthopedist performed an open reduction and internal fixation of three fragments.

• CPT^® codes: Use 25609 (Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments) to report the open reduction and internal fixation procedure. Append the code with modifier LT to indicate that the orthopedist performed the procedure on the patient’s left arm.

• ICD-10-CM codes: Assign S52.572A (Other intraarticular fracture of lower end of left radius, initial encounter for closed fracture) to report the fracture diagnosis.

Heidi Stout, CPC, COSC, President, Coder on Call, Inc.