American Skier Lindsey Vonn is not participating in the Sochi Olympic Winter Games due to severe knee injury. Vonn is the most recognized name in Alpine skiing as a four-time overall World Cup champion. She is also the first American woman to win an Olympic gold in the downhill.
At the world championships last February, Vonn tore two ligaments in her right knee during a high-speed crash which sidelined her for around 10 months. In a training crash in November, she re-tore her surgically repaired ACL, which is the key setback. She did make a huge comeback by finishing 40th, 11th and fifth in a set of World Cup races at Lake Louise in early December. But she lost her balance during a race at Val D’Isere, France during the last week of December, which sent her left ski into the air, forcing all her weight onto her right knee. As per her representative, Lewis Kay, an MRI taken after this accident showed an MCL sprain, which, coupled with the torn ACL made it impossible to stabilize her knee and safely ski again next month.
However, USA Today reported on a statement issued by Lewis Kay on January 15, 2014 which said that Lindsey Vonn successfully underwent ACL reconstruction surgery and is expected to make a full recovery for the 2015 World Championships in Vail, Colorado.
ACL Tear and MCL Sprains
The anterior cruciate ligament (ACL) inside the knee (which prevents the shinbone from sliding forward relative to the thigh bone) is the important stabilizer in the knee and it can be injured while landing awkwardly in pivot-heavy sports such as soccer, basketball and skiing. ACL injuries are classified according to the extent of damage to the ligament which are Grade I Sprain (some stretching and micro-tearing of the ligament), Grade II Sprain (Partial Disruption) and Grade III Sprain (Complete Disruption). ACL tear is a second or third degree sprain of the ACL.
ICD-9 codes for ACL tear
- 717.83: Old disruption of anterior cruciate ligament
- 844.2: Sprain of cruciate ligament of knee
ICD-10 codes for ACL tear (from October 1, 2014)
- M23.50: Chronic instability of knee, unspecified knee
- S83.51: Sprain of anterior cruciate ligament of knee
- S83.511: Sprain of anterior cruciate ligament of right knee
- S83.511A: Sprain of anterior cruciate ligament of right knee, initial encounter
- S83.511D: Sprain of anterior cruciate ligament of right knee, subsequent encounter
- S83.511S: Sprain of anterior cruciate ligament of right knee, sequela
- S83.512: Sprain of anterior cruciate ligament of left knee
- S83.512A: Sprain of anterior cruciate ligament of left knee, initial encounter
- S83.512D: Sprain of anterior cruciate ligament of left knee, subsequent encounter
- S83.512S: Sprain of anterior cruciate ligament of left knee, sequela
- S83.519: Sprain of anterior cruciate ligament of unspecified knee
- S83.519A: Sprain of anterior cruciate ligament of unspecified knee, initial encounter
- S83.519D: Sprain of anterior cruciate ligament of unspecified knee, subsequent encounter
- S83.519S: Sprain of anterior cruciate ligament of unspecified knee, sequela
Medial Collateral Ligament (MCL) is a band of tissue inside the knee which connects the thighbone to the bone of the lower leg and keeps the knee from bending inward. MCL sprain may occur due to activities that involve bending, twisting or a quick change of direction. There are Grade I (Mild), Grade II (Moderate) and Grade III (Severe) MCL sprains.
ICD-9 code for MCL sprain
- 844.1: Sprain of medial collateral ligament of knee
ICD-10 codes for MCL sprain
- S83.41: Sprain of medial collateral ligament of knee
- S83.411: Sprain of medial collateral ligament of right knee
- S83.411A: Sprain of medial collateral ligament of right knee, initial encounter
- S83.411D: Sprain of medial collateral ligament of right knee, subsequent encounter
- S83.411S: Sprain of medial collateral ligament of right knee, sequela
- S83.412: Sprain of medial collateral ligament of left knee
- S83.412A: Sprain of medial collateral ligament of left knee, initial encounter
- S83.412D: Sprain of medial collateral ligament of left knee, subsequent encounter
- S83.412S: Sprain of medial collateral ligament of left knee, sequela
- S83.419: Sprain of medial collateral ligament of unspecified knee
- S83.419A: Sprain of medial collateral ligament of unspecified knee, initial encounter
- S83.419D: Sprain of medial collateral ligament of unspecified knee, subsequent encounter
- S83.419S: Sprain of medial collateral ligament of unspecified knee, sequela
Arthroscopic Surgery
The treatment for ACL injuries depends upon the patient’s age, level of activity, associated injuries and the importance of returning to athletic activities. Even so, surgery is the only definitive treatment of complete ACL injuries. MCL sprain may require surgery only if it is coupled with severe injuries on other parts of your knee such as the ACL or meniscus. Surgery is not necessary for older individuals who do not complain of knee instability with recreational activities or work.
Majority of orthopedic surgeons opt for arthroscopic surgery rather than open surgery for ACL injuries as it is easy to view and work on knee structures, uses smaller incisions and may have fewer risks. Knee arthroscopy allows the surgeon to see the joint space of the knee with an endoscope (a long tube with a lens at each end) inserted through a small incision and perform surgery using surgical instruments inserted through other small incisions.
Common Knee Arthroscopic Procedures and their CPT codes
- 29850: Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; without internal or external fixation (includes arthroscopy)
- 29851: Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; with internal or external fixation (includes arthroscopy)
- 29855: Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed (includes arthroscopy)
- 29856: Arthroscopically aided treatment of tibial fracture, proximal (plateau); bicondylar, includes internal fixation, when performed (includes arthroscopy)
- 29866: Arthroscopy, knee, surgical; osteochondral autograft(s) (e.g., mosaicplasty) (includes harvesting of the autograft[s])
- 29867: Arthroscopy, knee, surgical; osteochondral allograft (e.g., mosaicplasty)
- 29868: Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral
- 29870: Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)
- 29873: Arthroscopy, knee, surgical; with lateral release
- 29874: Arthroscopy, knee, surgical; for removal of loose body or foreign body (e.g., osteochondritis dissecans fragmentation, chondral fragmentation)
- 29875: Arthroscopy, knee, surgical; synovectomy, limited (e.g., plica or shelf resection) (separate procedure)
- 29876: Arthroscopy, knee, surgical; synovectomy, major, two or more compartments (e.g., medial or lateral)
- 29877: Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)
- 29879: Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture
- 29880: Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving)
- 29881: Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)
- 29882: Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral)
- 29883: Arthroscopy, knee, surgical; with meniscus repair (medial AND lateral)
- 29884: Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure)
- 29888: Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction
- 29889: Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction
If an arthroscopic procedure is done at one site and an open procedure is performed at a different site, it is very important to use the appropriate modifier (-59 (used with the second procedure), RT (right knee), LT (left knee)) to indicate this to the insurer so that the physicians can receive the correct reimbursement. Physicians can partner with a professional medical billing and coding company having a dedicated team of AAPC certified coders to assign appropriate diagnostic codes for ACL and MCL injuries and procedure codes for arthroscopic surgeries.
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