Can anyone help me with this?? We have a patient who had a diagnosis of "right shoulder separation, acromioclavicular joint grade II". I know to go to dislocation for separation, but even there you have inferior, posterior, 100-200% displacement, and greater than 200% displacement. This is not the first one we've seen since ICD-10 started... but everytime I send it back to be specified further, they say "well i said grade ______". Which is nice, but I don't know what that means and that doesn't help narrow the codes down :/ And then I keep hearing over and over that they have no idea what the percentages of displacement mean and have no idea what the book is talking about.. I found this:
https://www.shoulderdoc.co.uk/article/60. Which from what I'm reading (I may totally be wrong), it looks like Grade I would be a sprain for the code and Grades III-VI would be the % codes. But what about Grade II?? would that be a subluxation code since subluxations are a partial dislocation??? I'm sorry, this is just frustrating and I'm hoping someone can help! Thank you!
Injuries to the Acromioclavicular (AC) Joints are very common among shoulder injuries. ICD-9 is of no help in coding these injuries , and ICD-10 has a very complicated and non-customary approach. Anatomically, it is the small joint between the lateral/distal end of the Clavicle/Collar Bone and the Acromial process of the Scapula/Shoulder Blade. It is located at the top and front of the shoulder. Females can locate it by putting a finger tip on their bra strap where it crosses their collar bone, then slide laterally towards the shoulder, and you can feel a mildly lumpy or irregular ridge from front to back.
There are some confusing terms associated with injuries to this joint. For injuries to this joint, the mildest injury would be a "sprain" in which there has been an injury to the joint, but without enough damage to cause the bone ends to be pushed or moved out of position relative to each other. Next more severe is "subluxation" which involves some relative shift/displacement of the parts, but without complete dislocation. Subluxation is a "Partial Dislocation," more than 0%, but less than 100%. Next is "Complete Dislocation," with greater than 100% displacement of parts, but not over 200%. The most severe category for ICD-10 is Greater than 200% displacement.
Traditionally, in Orthopedics, when we speak of a partial or complete dislocation, we describe it as where the proximal end of the distal bone is in relation to the distal end of the proximal bone of the joint (i.e. the proximal tibia in relation to the distal femur in a knee dislocation (anterior, posterior, lateral, medial)). But in AC Joint injuries we describe it as where the distal clavicle is in relation to the acromion (just the opposite). This is because most of these injuries result in the distal clavicle being "popped up" above the acromion. With the patient sitting or standing upright, the weight of the arm plus gravity pull the arm and shoulder (with the acromion) down (toward the floor) leaving the distal clavicle displaced upward (toward the ceiling). So we call this a superior dislocation of the AC Joint/Clavicle.
So, for the coding of these injuries by ICD-10, we have to merge the Traditional Orthopedic Terminology with the new/different codes from ICD-10.
1. The Traditional Grade I, Mild AC Joint injury would equal "Sprain" of the AC Joint: S43.51X _ for the right, and S43.52X _ for the left.
2. The Traditional Grade II, Moderate AC Joint injury would equal "Superior Subluxation of the AC Joint (<100% displacement of the clavicle):
S43.111 _ for the right, and S43.112 _ for the left.
3. The Traditional Grade III, Severe AC Joint injury would equal "Superior Dislocation of the AC Joint (>100% but <200% displacement of the
clavicle): S43.121 _ on the right, and S43.122 _ on the left.
4. The Traditional Grade IV, Very Severe AC Joint injury would equal "Superior Dislocation of the AC Joint > 200%: S43.131_ for the right, and
S43.132 _ for the left.
Inferior Dislocations of the Distal Clavicle and Posterior Dislocations of the Distal Clavicle at the AC Joint are extremely rare, usually resulting from
severe trauma.
Because these are Acute Injury (S) Codes, they require a 7th character (A, D, or S).
The External Cause Codes should also be determined and reported for completeness, a V or W Code for the underlying injury/acident, and Site Code (Y92), Activity Code (Y93), and External Cause Status Code (Y99).
Respectfully submitted by Alan Pechacek, M.D.
