Radiology Coding Alert

Lacerations and other Achilles injuries will have their own codes.

ICD-9 may roll Achilles tendon strains in with other ankle strains and sprains, but don’t expect ICD-10 to do the same. Be prepared to sort through multiple options when ICD-10 becomes effective next year.

Diagnosis: Tendons are cords of tissues connecting muscles to bones. Stretching or tearing of the tendon is called a strain. In contrast, a sprain typically refers to stretching or tearing of a ligament, which connects bones in joints.

ICD-9-CM Code:

845.09, Other ankle sprain

ICD-10-CM Codes:

S86.011A, Strain of right Achilles tendon, initial encounter

S86.012A, Strain of left Achilles tendon, initial encounter

S86.019A, Strain of unspecified Achilles tendon, initial encounter

S93.491A, Sprain of other ligament of right ankle, initial encounter

S93.492A, Sprain of other ligament of left ankle, initial encounter

S93.499A, Sprain of other ligament of unspecified ankle, initial encounter

ICD-9 coding rules: You should use 845.09 when the provider specifies the type of ankle sprain or strain but ICD-9 doesn’t provide a more specific code. A note with the code indicates it is appropriate for Achilles tendon injuries. Other options in this code range include:

845.00, Unspecified site of ankle sprain

845.01, Deltoid (ligament) ankle sprain

Internal collateral (ligament), ankle

845.02, Calcaneofibular (ligament) ankle sprain

845.03, Tibiofibular (ligament) sprain distal.

ICD-10 changes: ICD-10 introduces several changes you’ll need to understand to properly report ankle and Achilles tendon injuries. The ICD-10 codes require a sixth digit to indicate side: right, left, or unspecified.

The ICD-10 codes also require a seventh character to indicate the encounter:

A, initial encounter

D, subsequent encounter

S, sequela.

Documentation: To help you choose the appropriate code, you’ll need to know the side and the encounter as indicated above. The physician also will need to indicate the specific injury and the tendon or ligament involved. While Achilles tendon strains will be coded to S86.01-, ankle ligament sprains will be coded to S93.4- under ICD-10. As under ICD-9, ankle sprain options will vary based on whether the ligament is unspecified, calcaneofibular (S93.41-), deltoid (S93.42-), tibiofibular (S93.43-), or other (S93.49-).

Coder tips: In addition to the strain codes, ICD-10 includes distinct options for unspecified Achilles injuries (S86.00-), lacerations (S86.02-), and other specified injuries (S86.09-).

Remember: CMS has finalized the ICD-10 compliance date of Oct. 1, 2014. When ICD-10 goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.