Wiki Failed ACL ICD 10


Dothan, AL
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If a patient has a failed ACL tear of the left knee and ends up having an ACL revision done.... do we use the ICD 10 code S83.512D or T84.410A or both? Any help or input would be greatly appreciated.
There is not much detail to work with in this query, so I would have to make some assumptions or create the scenario as best I can. The patient at one time had a traumatic ACL Tear (S83.512A) which was treated by ACL Reconstruction. Some time after the original procedure, it was found that the "Reconstruction" had failed, but the reason for this is not given. If there was a new or recent injury that tore the reconstructed ligament, then you would be back to S83.512 _: Sprain of the ACL. But if here has not been a new injury, the S83.512 _ would not apply and more. This leaves the "Failed ACL Reconstruction" to be from some other non-traumatic cause. From my experience, this most commonly is from "Graft Failure," i.e. the grafted tissue just breaks down and fails. The next possibility would be "Fixation Failure" of the graft fixation method used, which is less frequent. This brings you to T84.410 _: Mechanical breakdown of "other" internal orthopedic device, implant (this would cover "Fixation Failure" above), or (tendon) "Graft Failure." This would cover both possibilities. However, there is another code possibility, T81.32X_: Disruption (Deep) of internal operation/surgical wound "closure" of ligament, which could be translated to "reconstructed' ligament. This would indicate a non-traumatic cause for the failure as well. But, of the two, I would probably go with the T84.410 _. However, I don't think either could be used alone or in isolation for coding the problem. You would have to use something related to the Knee Ligaments. There is M24.2: Disorder of the Ligaments (Chronic Instability secondary to Old Ligamentous Injury. But, and this is a bit But, this Code Set does not include the knee; therefore there is no M24.26 _, which would be a good code for the knee. The next possibility is M23.36 _: "Other" Instability of the (knee) joint. The documentation would have to support that the patient has subjective and/or objective findings of "Instability." What pain the patient has would probably be explained by the episodes of instability he experiences, so M25.56 _ would probably not be good to use or add to the diagnosis list.

Therefore, the net result of all this is using M25.36 _ to specify the knee as the site of trouble, and T84.410 _ for the ACL Ligament Reconstruction Failure.

I hope this helps. "Failed" anythings are a challenge to sort out and code.

Respectfully submitted, Alan Pechacek, M.D.
Thank you, sir. That helps me a lot. Interestingly, in the T80- series, there is an undernote stating that use of these codes requires the use of the trouble code which would be what the patient currently presents with which is usually some sort of pain or instability issue.

Thank you again for all the advice.