Orthopedic Coding Alert

Question: What is the correct ICD-9 code for a tear of the Achilles tendon?


Connecticut Subscriber

Answer: The answer depends on the tear itself. For an Achilles tendon tear that resulted from a traumatic event (such as coming down from a jump shot in basketball), you should report 845.09 (Sprains and strains of ankle and foot; ankle, other).

This code can be tough to track down because there is no listing under Achilles tendon in ICD-9's alphabetical index, and you might not be inclined to look under sprain codes for a tendon tear injury.

However, ICD-9 confirms that you-re in the right place when you arrive at the 840-848 range of codes by supplying guidelines about other conditions that also qualify as sprains or strains. For diagnosis coding, a sprain or strain includes avulsion, hemarthrosis, laceration, rupture or tear of a joint capsule, ligament, muscle or tendon.

If this definition isn't enough to ease your anxieties, ICD-9 also offers -Achilles tendon- as an example of when to use 845.09.

If, however, the patient suffers a spontaneous tendon rupture, 727.67 (Other disorders of synovium, tendon and bursa; rupture of tendon, nontraumatic; Achilles tendon) may be more appropriate. Ask your surgeon which code best describes the patient's injury.
 
You Be the Coder and Reader Questions were reviewed by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at UMDNJ-RWJ University Orthopaedic Group in New Brunswick, N.J.; and Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.