Billing Codes for Medial Collateral Ligament (MCL) Sprain of the Knee
The appropriate ICD-10-CM billing code for a medial collateral ligament sprain of the knee is S83.411 (right knee), S83.412 (left knee), or S83.419 (unspecified knee).
Primary Diagnostic Codes
- S83.411A - Sprain of medial collateral ligament of right knee, initial encounter 1
- S83.411D - Sprain of medial collateral ligament of right knee, subsequent encounter 1
- S83.411S - Sprain of medial collateral ligament of right knee, sequela 1
- S83.412A - Sprain of medial collateral ligament of left knee, initial encounter 1
- S83.412D - Sprain of medial collateral ligament of left knee, subsequent encounter 1
- S83.412S - Sprain of medial collateral ligament of left knee, sequela 1
- S83.419A - Sprain of medial collateral ligament of unspecified knee, initial encounter 1
Severity Classification Codes
MCL sprains are typically graded by severity, which affects both treatment and billing:
- Grade I (mild): Microscopic tearing of the ligament fibers with minimal instability 2, 3
- Grade II (moderate): Partial tear with some joint laxity 2, 3
- Grade III (severe): Complete tear with significant instability 2, 3
Associated Procedure Codes (CPT)
- 29530 - Strapping of knee 1
- 97110 - Therapeutic exercises 1
- 97140 - Manual therapy techniques 1
- 29882 - Arthroscopy, knee, surgical; with meniscus repair (if associated meniscal injury) 1
- 73721 - MRI knee without contrast (for diagnostic imaging) 1
- 73560 - Radiograph, knee, AP and lateral views 1
Imaging Considerations
- Radiographs are typically the initial imaging modality for knee injuries to rule out fractures 1
- MRI is the gold standard for diagnosing MCL injuries when clinical examination is inconclusive or when associated injuries are suspected 1
- Ultrasound may be used as a cost-effective alternative for isolated MCL injuries 1
Common Associated Conditions and Codes
- S83.211 - Bucket-handle tear of medial meniscus, current injury (often associated with MCL sprains) 1
- S83.511 - Sprain of anterior cruciate ligament (ACL injuries commonly occur with MCL injuries) 4
- M17.0 - Primary osteoarthritis of knee (for long-term sequelae) 5
Documentation Requirements
For proper billing, ensure documentation includes:
- Specific laterality (right, left, or bilateral) 1
- Encounter type (initial, subsequent, or sequela) 1
- Grade of sprain (I, II, or III) 2
- Mechanism of injury 1, 6
- Associated injuries if present 4
- Treatment plan 2, 7
Billing Pitfalls to Avoid
- Using unspecified codes when laterality is known 1
- Failing to update encounter type for follow-up visits 1
- Not documenting associated injuries that may require separate coding 4
- Inadequate documentation of physical exam findings to support the diagnosis 1, 6
Remember that accurate coding is essential for proper reimbursement and to establish medical necessity for treatment procedures, especially if surgical intervention is required for higher-grade MCL sprains or associated injuries 2, 3.