Orthopedic Coding Alert

Question: Notes indicate that the orthopedist performed a level-three evaluation and management (E/M) service for an established patient with, according to the note, a “R acromioclavicular joint dislocation, 150%.” What does the note mean, and how do I choose an ICD-10 code for this patient’s injury?

California Subscriber

Answer: For your claim, you’ll append S43.121 (Dislocation of right acromioclavicular joint, 100%-200% displacement) to 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity …) to represent the patient’s dislocation.

Now, for a little primer on these diagnosis codes. A dislocation of the acromioclavicular joint at 100% to 200% displacement means the injury is a complete displacement of the joint out of normal position — and the injury results in a 100 to 200 percent displacement of parts. You’ll choose one of the following diagnosis codes for a 100 to 200 percent displacement, depending on encounter specifics:

• S43.121
• S43.122 — Dislocation of left acromioclavicular joint, 100%-200% displacement
• S43.129 — Dislocation of unspecified acromioclavicular joint, 100%-200% displacement.

A dislocation of the acromioclavicular joint at greater than 200% displacement also means a complete displacement of the joint out of normal position — however, these injuries result in a 200 percent or more displacement of parts. You’ll choose one of the following diagnosis codes for a displacement of 200 percent or more, depending on encounter specifics:

• S43.131 — Dislocation of right acromioclavicular joint, greater than 200% displacement
• S43.132 — Dislocation of left acromioclavicular joint, greater than 200% displacement
• S43.139 — Dislocation of unspecified acromioclavicular joint, greater than 200% displacement.

If these definitions seem a little unclear, check with your providers and payers about what they consider 100 to 200 percent displacement versus more than 200 percent displacement. Coders are often flummoxed — and with good reason — about where each diagnosis code group begins and ends. The interpretation of each of these diagnosis codes could differ by payer, service, or claim, so be sure before choosing any of these ICD-10 codes.