A sprain occurs when direct or indirect trauma (for example, a fall, a blow to the body) knocks out a joint from its actual position and overstretches it and even ruptures the supporting ligaments in severe cases. The prolonged, repetitive movement of muscles and tendons cause chronic strains. Athletes are more vulnerable to these injuries as they are more involved in sports and exercises that carry the risk of both injuries. Orthopedicians have to report sprains and strains accurately on their medical claims using the appropriate ICD-10 codes.
If the ICD-9 coding system uses a single code for strain and sprains, there are separate codes for these conditions in the new coding system. Let’s take a detailed look into the more comprehensive ICD-10 coding for sprains and strains.
More Specificity
Compared to ICD-9 codes, ICD-10 is more specific, especially in terms of injury location. Let us consider medical coding for sprain and strain of the hip to understand this. In ICD-9, only a few codes are used to specify both the sprain and strain of hip such as:
- 843: Sprains and strains of hip and thigh
- 843.0: Iliofemoral (ligament) sprain
- 843.1: Ischiocapsular (ligament) sprain
- 843.8: Sprains and strains of other specified sites of hip and thigh
- 843.9: Sprains and strains of unspecified site of hip and thigh
ICD-10 has several codes in the sprains and strains category, depending upon the exact location and episode of care.
Sprain
- S73.1: Sprain of hip
- S73.10: Unspecified sprain of hip
- S73.101: Unspecified sprain of right hip
- S73.101A: Unspecified sprain of right hip, initial encounter
- S73.101D: Unspecified sprain of right hip, subsequent encounter
- S73.101S: Unspecified sprain of right hip, sequela
- S73.102: Unspecified sprain of left hip
- S73.102A: Unspecified sprain of left hip, initial encounter
- S73.102D: Unspecified sprain of left hip, subsequent encounter
- S73.102S: Unspecified sprain of left hip, sequela
- S73.109: Unspecified sprain of unspecified hip
- S73.109A: Unspecified sprain of unspecified hip, initial encounter
- S73.109D: Unspecified sprain of unspecified hip, subsequent encounter
- S73.109S: Unspecified sprain of unspecified hip, sequela
- S73.11: Iliofemoral ligament sprain of hip
- S73.111: Iliofemoral ligament sprain of right hip
- S73.111A: Iliofemoral ligament sprain of right hip, initial encounter
- S73.111D: Iliofemoral ligament sprain of right hip, subsequent encounter
- S73.111S: Iliofemoral ligament sprain of right hip, sequela
- S73.112: Iliofemoral ligament sprain of left hip
- S73.112A: Iliofemoral ligament sprain of left hip, initial encounter
- S73.112D: Iliofemoral ligament sprain of left hip, subsequent encounter
- S73.112S: Iliofemoral ligament sprain of left hip, sequela
- S73.119: Iliofemoral ligament sprain of unspecified hip
- S73.119A: Iliofemoral ligament sprain of unspecified hip, initial encounter
- S73.119D: Iliofemoral ligament sprain of unspecified hip, subsequent encounter
- S73.119S: Iliofemoral ligament sprain of unspecified hip, sequela
- S73.12: Ischiocapsular (ligament) sprain of hip
- S73.121: Ischiocapsular ligament sprain of right hip
- S73.121A: Ischiocapsular ligament sprain of right hip, initial encounter
- S73.121D: Ischiocapsular ligament sprain of right hip, subsequent encounter
- S73.121S: Ischiocapsular ligament sprain of right hip, sequela
- S73.122: Ischiocapsular ligament sprain of left hip
- S73.122A: Ischiocapsular ligament sprain of left hip, initial encounter
- S73.122D: Ischiocapsular ligament sprain of left hip, subsequent encounter
- S73.122S: Ischiocapsular ligament sprain of left hip, sequela
- S73.129: Ischiocapsular ligament sprain of unspecified hip
- S73.129A: Ischiocapsular ligament sprain of unspecified hip, initial encounter
- S73.129D: Ischiocapsular ligament sprain of unspecified hip, subsequent encounter
- S73.129S: Ischiocapsular ligament sprain of unspecified hip, sequela
- S73.19: Other sprain of hip
- S73.191: Other sprain of right hip
- S73.191A: Other sprain of right hip, initial encounter
- S73.191D: Other sprain of right hip, subsequent encounter
- S73.191S: Other sprain of right hip, sequela
- S73.192: Other sprain of left hip
- S73.192A: Other sprain of left hip, initial encounter
- S73.192D: Other sprain of left hip, subsequent encounter
- S73.192S: Other sprain of left hip, sequela
- S73.199: Other sprain of unspecified hip
- S73.199A: Other sprain of unspecified hip, initial encounter
- S73.199D: Other sprain of unspecified hip, subsequent encounter
- S73.199S: Other sprain of unspecified hip, sequela
Strain
- S76.01: Strain of muscle, fascia and tendon of hip
- S76.011: Strain of muscle, fascia and tendon of right hip
- S76.011A: Strain of muscle, fascia and tendon of right hip, initial encounter
- S76.011D: Strain of muscle, fascia and tendon of right hip, subsequent encounter
- S76.011S: Strain of muscle, fascia and tendon of right hip, sequela
- S76.012: Strain of muscle, fascia and tendon of left hip
- S76.012A: Strain of muscle, fascia and tendon of left hip, initial encounter
- S76.012D: Strain of muscle, fascia and tendon of left hip, subsequent encounter
- S76.012S: Strain of muscle, fascia and tendon of left hip, sequela
- S76.019: Strain of muscle, fascia and tendon of unspecified hip
- S76.019A: Strain of muscle, fascia and tendon of unspecified hip, initial encounter
- S76.019D: Strain of muscle, fascia and tendon of unspecified hip, subsequent encounter
- S76.019S: Strain of muscle, fascia and tendon of unspecified hip, sequela
Episode of Care
This seventh character extension is primarily used for injuries and consequences of external causes and therefore it is very significant when coding for sprains and strains. Let’s see what each type refers to.
- Initial encounter – This is defined as the period of time during which the patient is receiving active treatment for injuries. The corresponding ICD-10 code can be used many times by the same provider. It can also be used by all practitioners providing the active treatment.
- Subsequent encounter – This is for visits after the patient receives treatment for the injury. The corresponding code is used for every visit in which the patient receives routine care for the injury during the recovery phase. It can be used in case of medication adjustment, physical therapy after the active treatment and follow-up visits after the active treatment.
- Sequela – This indicates that a residue problem continues even after resolving the active phase of an injury. There is no timeline specified to use sequela code. However, it requires two codes to report sequela. The result of the injury or the reason for which the patient is being treated currently is the first diagnosis code while the cause or initial/original injury is specified as the second code with ‘S’ extension. The ‘S’ extension code is not used to report surgical complications.
In ICD-10 coding, additional documentation is required to capture the exact location of the strain or sprain and episode of care. To ensure accurate documentation, coding and maximum reimbursement orthopedicians can consider obtaining the support of expert medical coders and billers.
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