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Thread: old vs new meniscus tears

  1. #31


    AAPC: Back to School
    our surgeon dictates that there is a medial menicus tear but also states chronic pain. would this qualify to use from the 717.X codes?

  2. #32
    Join Date
    Apr 2007
    Richmond, Virginia

    Default Derangement vs. Tear

    Internal derangement of the knee is a mechanical disorder of the knee which interferes with normal joint motion and/or mobility. A fragment of soft tissue or bone that suddenly becomes interposed between the articular surfaces is the classic cause of internal derangement. The misplaced fragment can be radiolucent or radiopaque. The most frequent cause of locking is entrapment of the radiolucent meniscus.
    The most common IDK is the torn meniscus.
    There are two principal cartilaginous structures in the knee joint - the articular cartilage and the menisci. The articular cartilage envelopes the bony ends of the tibia, femur and patella in contact with the joint. The menisci play a vital role in providing joint stability, impact absorption, and lubrication. Both of these structures can be acutely damaged by trauma or chronically damaged by cumulative joint trauma. Injury to the menisci generally results from traction, compression, torque forces, or a combination of all three.
    The cruciate ligaments are most important in ensuring normal knee function. Damage to these ligaments contributes to significant impairment and disability. The anteriorcruciate ligament (ACL) is the more critical and is the most frequently involved in injury.
    The complex interplay between instability, torn menisci, athletic activities, muscle control, and cumulative joint trauma ultimately leads to a degenerative change in the knee. It is often unclear what mechanism caused the disability, e.g. the original injury, repeated locking, instability, high athletic demands, powerful muscular contractions, repeated trauma or altered mechanics.
    Osteochondritis dissecans of the femoral condyle is one of the most common conditions which generate radiopaque osteocartilaginous loose bodies. It is three times more common in men than in women. Osteochondritis dissecans of the patella, in some cases, appears to be due to a tangential or shear fracture secondary to subluxation. Persons with intra-articular loose bodies of the knee will develop degenerative arthritis. Time until presentation of arthritis is dependent, in part, on activity level, insofar as the more active the person, the earlier the onset of arthritis.

    In ICD-9 CM there are 2 codes to choose:
    717 – Derangement (derangement MIGHT include a torn meniscus, but involves more than the meniscus, such as inclusion of the ligaments etc- Basically the knee is completely messed up inside, not just a simple torn meniscus). The 717 codes in general include “old meniscus tears”…because clinically many patient suffer degenerative changes related to the surgery itself…. So they can then DEVELOP a derangement later.
    836.0 – Tear of Medial Cartilage or meniscus of knee-,current. This is a simple meniscus tear. No other knee joint involvement and it is “new or current”.
    Brian R. Boyce, CPC, CPC-I

    Healthcare Operations, Regulatory Compliance & Coding Consultant

  3. #33
    Join Date
    Apr 2007
    Kansas City, MO


    In our practice since the 717.XX series specifically states it includes old ruptures or tears we use these codes when there is no specific DOI, patient's are often vague about when knee/joint pain begins even when it was due to an injury. If you don't have a DOI specified on your claim it could create problems with payment. Use of the 836.0X codes requires a specific DOI, just saying 2 years ago is not specific enough. So, we bill this only when we have a specific DOI.

  4. #34
    Join Date
    Apr 2007
    Loma Linda CA


    Thank you Brian - this is the way I was taught to code.

    Marybeth Holland CPC

  5. #35

    Question 836.x versus 717.x codes

    Ladies, how would the visit be coded when you have osteoarthritis in the knee joint along with large horizontal and free edge tears of the posterior horn and body medial meniscus. Complex tear of the entire lateral meniscus with collection of anterior parameniscal cysts. Would both the osteoarthritis code and the injury code 836 series be coded. Patient fell years ago but no mention of an injury recently.

  6. #36


    Differences between Acute and Chronic Injury in Medical Coding/Billing
    By Karen Smiley from Medical Billing and Coding For Dummies

    Many physician encounters are due to injury, and the difference between disease and injury can be blurred which can cause problems for medical coders and billers. A patient may suffer bruising due to disease, for example, but have no history of injury. This is why, for the purposes of coding, you want to be familiar with the varying levels of injury:

    Acute injury: Damage to the body incurred by accident

    Chronic injury: Damage to the body that is a result of overuse or aging

    Treatment may differ depending upon whether the injury is acute or chronic. With an acute injury, the injury has just happened, and the tissue in question is still viable. A chronic injury, on the other hand, has occurred over time or is a once-acute injury that has only partially healed.

    Often, treatment of a chronic injury requires additional work: A surgeon may need to remove non-viable tissue or possibly use tissue grafts to successfully complete the repair. Thus, a chronic injury is often more time-consuming because the body?s tendency to heal itself can result in scar tissue (called fibrosis).

    If you have any question about whether the injury is acute or chronic, investigate further before choosing a procedure code. If the patient history is available for review, you can abstract the information you need to choose the correct code.

    In this case, you would review the patient history to see when the patient first came in for treatment, or you would look for the patient information page to see whether the patient indicated when the injury occurred.

    Many times, patients say that they have no idea why the problem occurred. In this situation, you probably have to use chronic injury-related codes unless the provider says otherwise.

    Because the story may be more complicated than a one-time incident, don?t assume that an injury is acute. When you?re unsure, investigate. Check for clues in the report. For example, words such as pathological often indicate a disease process that would point to chronic, not acute, injury.

  7. #37


    If 3 months ago playing hockey, I would definitely use the 836.X. I may be wrong,but my rule of thumb is if the patient can pin point the "injury", then it is the 836.X - fall, trip, twist, etc.

    If they wake up one day with pain or the knee becomes painful for no reason,with no trauma whatsoever and it turns out to be a meniscal tear, then I code degenerative.

  8. #38


    In your scenario, Lisa, there was an injury three months ago. It was likely treated conservatively and, when that failed, he was brought to the OR. I would, without question, code acute... the 836 series. There was an injury and patient was fine before that. Definitely acute !!

  9. #39

    Default Derangement vs Tear

    Thanks you guys! This is exactly what I was looking for! Just wish I had found it sooner so my grades would look a little better!!

  10. #40


    I usually code "7" codes unless the surgeon states that it is due to an injury. In order to use "8" codes, you must have a date of injury. If the injury happened 5 years ago, or the patient denies trauma, I use a "7" code. Unless it is a W/C claim, I don't enter a date of injury that was years ago.

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