Orthopedic Coding Alert

Tip: You’ll need to specify the joint and the side.

When a patient presents with a sprain of the wrist, this means the patient presents with an injury to the ligaments of the wrist. 

Currently, you have these ICD-9 options:

• 842.00, Sprain of unspecified site of wrist
• 842.01, Sprain of carpal (joint) of wrist
• 842.02, Sprain of radiocarpal (joint)(ligament) of wrist
• 842.09, Other wrist sprain

ICD-10-CM: When ICD-10 hits, you’ll have numerous more options: 

• S63.501-, Unspecified sprain of right wrist
• S63.502-, Unspecified sprain of left wrist
• S63.509-, Unspecified sprain of unspecified wrist
• S63.511-, Sprain of carpal joint of right wrist
• S63.512-, Sprain of carpal joint of left wrist
• S63.519-, Sprain of carpal joint of unspecified wrist
• S63.521-, Sprain of radiocarpal joint of right wrist
• S63.522-, Sprain of radiocarpal joint of left wrist
• S63.529-, Sprain of radiocarpal joint of unspecified wrist
• S63.591-, Other specified sprain of right wrist
• S63.592-, Other specified sprain of left wrist
• S63.599-, Other specified sprain of unspecified wrist

Each of these codes requires a 7th character: A (initial encounter), D (subsequent encounter), or S (sequela).

What’s different: After October 1, 2015, you will need to report the code based on what joint was sprained and whether the sprain occurred in the right or the left wrist. You do have codes for unspecified, but you should always code to the highest specificity. Also, don’t forget to include the specifics about this encounter (initial, subsequent, sequela).

Documentation: Your provider probably already specifies whether the sprain occurred in the right or left wrist, but now you have new codes to reflect that. 

Here is how you will locate this code in your Alphabetic Index:

Sprain (joint) (ligament)- wrist S63.50-

- - carpal S63.51-
- - radiocarpal S63.52-
- - specified site NEC S63.59-

Coding tips: You will see an Excludes1 note under S63.52- stating that you should not report these codes with traumatic rupture of radiocarpal ligament (S63.32-) codes.

You will also see an Excludes2 note under the S63- category stating that you may report these codes with strain of muscle, fascia and tendon of wrist and hand (S66.-) codes, but your physician has to document both conditions.