ED Coding and Reimbursement Alert

Question: A patient reports to the ED complaining of pain and swelling in her right knee. The ED physician diagnoses a meniscal tear during the course of a level- three E/M service and refers the patient to a specialist. How should I code this encounter?


Oregon Subscriber

Answer: A meniscal tear is a common injury involving torn knee cartilage. There are two types of tears, and you-ll need to go back and check the notes to see which type of tear this patient suffered before coding this scenario.

Why? Your ICD-9 code choice depends on it.

On the report, you should see documentation that the patient has torn one of two knee menisci: the medial meniscus, located on the inside of the knee, and/or the lateral meniscus, located on the outside of the knee. These menisci serve as shock absorbers for the knee but are easily torn as a result of wear-and-tear by athletes. Patients may also tear the menisci as a result of trauma, such as squatting or twisting the knee.

Option 1: If the patient suffered a medial meniscus tear, you should report 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of moderate complexity) for the E/M--with 836.0 (Tear of medial cartilage or meniscus of knee, current) attached to represent the tear.

Option 2: If the patient suffered a lateral meniscus tear, you should report 99283 for the E/M with 836.1 (Tear of lateral cartilage or meniscus of knee, current) attached to represent the tear.

Option 3: If the notes do not specify the injury as medial or lateral, you should report 99283 for the E/M with 836.2 (Other tear of cartilage or meniscus of knee, current) attached to represent the tear.

Check for degeneration: Meniscus tears can also be degenerative, especially in the older population. If the operative notes indicate that the patient has a degenerative meniscus tear, choose a code from the 717.0-717.49 set. So if the physician diagnoses an old bucket handle tear in a patient's medial meniscus, you-d report 717.0 (Old bucket handle tear of medial meniscus).