# old vs new meniscus tears



## ammontagano

Can anybody explain the difference between 836.0/836.1 (current tears) and 717.2/717.43 (old derangement of meniscus).   Is there a time frame that changes the dx code to an old tear?


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## mbort

I was always taught that you always code current tear (836.0/836.1) unless the surgeon specifically states that it is a degenerative tear(717.X series).  

I had a real hard time doing this for many years and argued and argued, and was noncompliant with what I had learned because I didnt want to give the patient an "injury" diagnosis...then one day....I was DINGED in an audit!!  

The example given was basically stating that if you always code degenerative, you are giving the patient a dx/disease they may or may not have.


Hope this helps,
Mary, CPC, COSC


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## nyyankees

Thanks for the clarification on that....been using the 717.x for anesthesia coding and HATED it!!!


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## ammontagano

Thanks Mary for the input. I was taught the same way (always code current unless degenerative is specified) and was doing this until the ASC we work out of started requesting our op notes for their billing purposes and they are now telling me that if the doc states in the op note that the patient had, for example, a "tear of the posterior horn of the medial meniscus", the ASC is telling me we should code 717.2.  Is that correct?  The op note or any of the previous office visit notes state that this is an old injury.  Thanks.


Ann Marie, CPC


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## Jamie Dezenzo

I just had an op note and in H&P notes indicated DOI 8/2008 from a fall (9 months ago) and still coded 836.1 for the lateral tear.


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## mbort

I believe your ASC is incorrect.  That is not the correct way to code it.


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## CrysLednum

I see what you are saying Mary - but I am wondering, I use the 836 series codes when it is a recent injury.  But when it comes to an injury that occurred say 2 years ago I am using the 717.X series.  Are you saying that you would still use the injury codes?


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## mbort

CrysLednum said:


> I see what you are saying Mary - but I am wondering, I use the 836 series codes when it is a recent injury.  But when it comes to an injury that occurred say 2 years ago I am using the 717.X series.  Are you saying that you would still use the injury codes?



If the note specifically states that the injury occurred 2 years ago then you would be ok or if the note specifically states that its a degenerative tear.

I do surgical coding so this is RARELY documented in an operative note therefore 98% of the time I am stuck using the 836.X series

Mary, CPC, COSC


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## CrysLednum

Got it thanks!


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## Lisa Bledsoe

So ladies - where does one find the definition of old vs current injury?  I have a PA telling me if it's more than 2 weeks since the injury it is 717.XX.  The note states that the onset of pain was 3 months ago while playing hockey.  Thoughts?


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## LTibbetts

I always thought that it was 3 months or more to consider it an old injury and anything more recent than that would be considered a current injury. Is this correct?


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## Anna Weaver

*old vs new*

I will have to check, but I think I read somewhere that if they have had ongoing treatment and it's not resolved, then it's still coded as current. Say a knee injury 6 months ago, but they were trying conservative treatment first. Physical therapy, injections and such. Then they went for surgery, I still code the current instead of the chronic as the treatment never stopped. 
Unfortunately, I believe this is one of those that will never be agreed upon. LOL. Will see if I can find where I read and add when I do.


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## Lisa Bledsoe

Thanks Anna!


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## Anna Weaver

*old vs new*

Well, I have looked through all my Ortho information and I cannot find anywhere that lists a time frame on old vs new. So, I started looking at articles and such. WOW!! Was I educated. 
And the answer is:  It depends!! LOL. Some say 6 weeks from injury is considered chronic. Some say 3 months is considered Chronic. Other's say it depends on the persons age or whether it was a traumatic injury. There really doesn't seem to be an answer that everyone agrees on. There are some really interesting articles out there though.
Sorry, I really thought I had the answer to this one. LOL, looks like... not so much.


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## Alta

*RE: old vs new*

Glad to hear everyone wondering about this one!  As a new coder, I was very frustated by this and asked again and again and no one could really say when it is considered old and when it is new.  I code them now as old unless they happened very recently, say a week.  If you are going to be "dinged" for it, as someone mentioned above, doesn't there need to be a reference to refer to that you are violating?  A guideline?


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## nyyankees

jamshidi said:


> glad to hear everyone wondering about this one!  As a new coder, i was very frustated by this and asked again and again and no one could really say when it is considered old and when it is new.  I code them now as old unless they happened very recently, say a week.  If you are going to be "dinged" for it, as someone mentioned above, doesn't there need to be a reference to refer to that you are violating?  A guideline?



excellent point...i'd be interested to hear that


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## mitchellde

Also remeber we can use late effect codes and sometimes this is preferable to the 717 codes for instance if the encounter is for treatment of pain from the injury 2 weeks ago I would got for the pain and then the late effect code I think it more acurately fits.  As for surgery then what are they correcting, if the y tried conservative methods and failed and moved straight to surgey then I say the tear is still current, if on the other hand the patient drug their fet for a long period of time and was not consistent witht the treatment and then the physician decided that the only cure was surgical I will lean towards the 717 codes, I think it is all very dependent on documentation and the old vs current is going to be left to the physician.


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## vickimcneill

> #2          05-28-2009, 10:06 AM
> mbort
> True Blue   Join Date: Apr 2007
> Location: ENGLEWOOD/DENVER
> Posts: 1,997
> 
> 
> 
> 
> --------------------------------------------------------------------------------
> 
> I was always taught that you always code current tear (836.0/836.1) unless the surgeon specifically states that it is a degenerative tear(717.X series).
> 
> I had a real hard time doing this for many years and argued and argued, and was noncompliant with what I had learned because I didnt want to give the patient an "injury" diagnosis...then one day....I was DINGED in an audit!!
> 
> The example given was basically stating that if you always code degenerative, you are giving the patient a dx/disease they may or may not have.
> 
> 
> Hope this helps,
> Mary, CPC, COSC



So Mary, if a Dr. states "medial and lateral meniscal tears, *severe medial compartment osteoarthritis*, synovitis, and a partial ACL tear" would you code 717.xx? Just want to clarify what you are saying.


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## martnel

I was told if they have a date or can recall an injury, it is acute.  If it just happened over time, its chronic/old.  My doctors almost never say anything about that in the Op report, so I go back in their office notes to see what happened.  Is that wrong to do that?


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## codedog

This thread is very interesting. Some  SAY 717.? Others say 836.0 , , I know SOMETIMES WHEN i coded IT AS 836.0 OR 836. the insurance company wanted an accident report-at least that's what the billers said, I work at an asc and we don't get the accident report.


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## jdrueppel

Yes, very interesting that there are so many opinions.  
I bill for anesthesia and we do not have EMR/Op Report access at 3 of our 6 facilities.  That being said we had to come up with an acceptable consistent billing guideline.  We only bill traumatic 836.x if service is Work Comp, trauma admit, or if anesthesia provider documents traumatic.  If no trauma/accident indicator is documented by our provider we bill 717.x.  This guideline has survived annual external compliance audits with no ill effects because we are consistent.  There have only been a couple times in 18 years that a patient has called & asked us to change to the traumatic dx due to them having "accident" benefits on their health insurance policy--and I haven't had anyone ask me to change from traumatic to non traumatic.  (Of course, the traumatic dx is confirmed with the surgeon and/or facility before the diagnosis is actually changed).  Just my two cents.

Julie, CPC


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## codedog

I purchased the CASCC practicum, should have some time this weeked to see  if they have an example of tears on  their exercise test. I will let  yall  know the outcome. I tell you this is the most interesting thread I read so far


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## coderguy1939

I don't know if this will be of any help, but there is a 2007 Jan-Feb Ortho Coding Alert discussing correct CPT codes for RCR repairs and it essentially states that for most coding situations acute would be for an injury that is less than 3 months old.  It goes on to say that unless the surgeon documents an injury of less than 3 months, you'd probably use the the CPT for a chronic RCR rupture.  Can this be translated to all joint injuries and DX codes?  I don't know.  I guess the best thing to do is query the doctor.


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## CrysLednum

LOL!! Just to throw out another number - I was always told the if the injury is 6 months or less it is Acute and anything older than that is Old/Chronic!   I have used that guideline and I am trying to find my paperwork on it - but thankfully, most times, our surgeons state in the note whether or not it is degenerative or a recent injury.


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## ASC CODER

I know this is an older thread but to through my two cents in what if the doc reports medial meniscus tear and also has underlying degenerative arthritic changes in medial compartment.

so now we have both.....do we post both???


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## PLAIDMAN

Wow, I was taught the complete opposite.  I was taught the timeline from acute to chronic is approx 3 mos.

If I have a patient who has a  7 month old injury then I would code 717.xx, the code is not just a "degenerative" code the definition includes "old tears" the patient may not even have any DJD but the tear is still old.

?????


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## ASC CODER

Anyone have a definitive answer????????????


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## mitchellde

lgentry said:


> I know this is an older thread but to through my two cents in what if the doc reports medial meniscus tear and also has underlying degenerative arthritic changes in medial compartment.
> 
> so now we have both.....do we post both???



is the tear due to the degenerative changes?


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## ASC CODER

he just states both, patient has degenerative and a tear... and he states it several times in op report


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## mbort

for this scenario, if there is no mention of injury in the op report, I would code the 717.X series.  Check the H & P to see if there is more info as well.  Chronic pain is a good indicator


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## carriep9829

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?


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## BoyceSolutions

*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”.


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## debwoods65

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.


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## mholland

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

Marybeth Holland CPC


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## erjones

*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.


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## kfissler@medkoder.com

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.
http://www.dummies.com/how-to/content/differences-between-acute-and-chronic-injury-in-me.html


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## madgejones10

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.


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## madgejones10

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 !!


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## Ellen77

*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!!


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## caromissunc1

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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