In our practice, It's common to have this many codes. (Orthopedics) We prioritize the dx and only bill one claim. Remember with many conditions, ICD-10 does not require extraneous pain codes to be included. Especially for sprains. For example, S338XA is a lumbar strain. So low back pain M545 is not necessary to be included. I would advise ensuring that the DX's are not redundant. Also worth mentioning, remember bilateral codes should be combined when possible, instead of broken up into separate codes. This also helps avoid denials. For example, Carpal tunnel bilateral is G5603. So these codes (G5600, G5601, and G5602) are redundant, And only G5603 should be on the claim if documentation supports Bilateral condition. Lastly, encounters that have multiple 7th character ICD-10 codes can be narrowed down by looking at the encounter. For example, S338XA and S338XD are for initial and subsequent lumbar strain encounters. Only use the appropriate one and remove the extraneous/less accurate one. Hope this helps!