From the Research
For suspected PCL injury not yet confirmed by MRI, the appropriate ICD-10 code to use is S83.529A (Sprain of unspecified cruciate ligament of unspecified knee, initial encounter). If you know which knee is affected, you can use S83.521A for the right knee or S83.522A for the left knee. These codes are appropriate for suspected ligament injuries awaiting diagnostic confirmation. Once the MRI confirms the PCL injury, you should update the coding to the more specific S83.52- series codes that identify PCL injuries specifically. The "A" at the end indicates initial encounter, which is appropriate during the diagnostic phase. These codes allow for proper documentation of the suspected injury while diagnostic workup is in progress, ensuring appropriate reimbursement for evaluation and initial management. The coding can be refined later based on MRI findings to reflect the confirmed diagnosis, as MRI remains the gold standard imaging study for detecting ligament injuries 1. It is essential to distinguish between an isolated or multiligament injury and whether the problem is acute or chronic, as this will impact the treatment and management of the patient 2. Additionally, the location and severity of the PCL tear, as well as the presence of associated injuries, can influence the surgical management of the patient 3. Therefore, accurate diagnosis and documentation using the appropriate ICD-10 codes are crucial for ensuring proper treatment and reimbursement. Some studies have shown that MRI can be less accurate in evaluating chronic PCL injuries, with an accuracy of 57% in diagnosing chronic PCL injury 4. However, this does not change the initial approach to coding suspected PCL injuries. The key is to use the appropriate code for the initial encounter and refine it later based on the confirmed diagnosis. In terms of associated injuries, studies have shown that posterolateral corner, ACL, collateral ligament, meniscus, patellar retinaculum, and gastrocnemius muscle injury, and fracture are more likely to result in surgical management 3. Overall, the use of S83.529A as the initial code for suspected PCL injury not yet confirmed by MRI is supported by the available evidence.