Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma (A57079)

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Local Coverage Article: Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma (A57079)

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Contractor Information

CONTRACTOR NAME CONTRACT TYPE CONTRACT JURISDICTION STATE(S) NUMBER

Noridian Healthcare Solutions, A and B MAC 01111 - MAC A J - E California - Entire State LLC

Noridian Healthcare Solutions, A and B MAC 01112 - MAC B J - E California - Northern LLC

Noridian Healthcare Solutions, A and B MAC 01182 - MAC B J - E California - Southern LLC

Noridian Healthcare Solutions, A and B MAC 01211 - MAC A J - E American Samoa LLC Guam Hawaii Northern Mariana Islands

Noridian Healthcare Solutions, A and B MAC 01212 - MAC B J - E American Samoa LLC Guam Hawaii Northern Mariana Islands

Noridian Healthcare Solutions, A and B MAC 01311 - MAC A J - E Nevada LLC

Noridian Healthcare Solutions, A and B MAC 01312 - MAC B J - E Nevada LLC

Noridian Healthcare Solutions, A and B MAC 01911 - MAC A J - E American Samoa LLC California - Entire State Guam Hawaii Nevada Northern Mariana

Created on 09/28/2019. Page 1 of 33 CONTRACTOR NAME CONTRACT TYPE CONTRACT JURISDICTION STATE(S) NUMBER

Islands

Article Information

General Information

Original Effective Date 10/01/2019

Article ID Revision Effective Date A57079 N/A

Article Title Revision Ending Date Billing and Coding: Injections - Tendon, Ligament, N/A Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma Retirement Date N/A Article Type Billing and Coding

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Created on 09/28/2019. Page 2 of 33 codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816 or Laryssa Marshall at (312) 893-6814. You may also contact us at [email protected].

CMS National Coverage Policy

Title XVIII of the Social Security Act, 1862(a)(1)(A) allows coverage and payment for only those services that are considered to be medically reasonable and necessary.

Title XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

CMS Manual System, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §150.7.

Article Guidance

Article Text:

The following billing and coding guidance is to be used with its associated Local Coverage Determination.

Injection therapies for Morton's neuroma do not involve the structures described by CPT code 20550 and 20551 or direct injection into other peripheral nerves but rather the focal injection of tissue surrounding a specific focus of inflammation on the foot. These therapies are not to be coded using 20550, 20551, 64450, 64640 or other assigned CPT codes. Rather, the provider of these therapies must bill with CPT code 64455 or 64632 Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton's neuroma) as the correct CPT code for the service.

Injections for plantar fasciitis are addressed by 20550 and ICD-10-CM M72.2. Injections for other tendon origin/insertions by 20551. Injections to include both the plantar fascia and the area around a calcaneal spur are to be reported using a single 20551.

The clinical record should include the elements leading to the diagnosis and treatment decision to use injection. If the number of injections exceeds three to the same site or local area in a six month period, the record must justify these added injections since the presumed need for further injections should raise the issues of correct diagnosis or correct choice of therapy as well as concerns for adverse side effects. Records must be made available upon request.

The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This policy does not take precedence over CCI edits. Please refer to the CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

When the documentation does not meet the criteria for the service rendered or the documentation does not establish the medical necessity for the services, such services will be denied as not reasonable and necessary under Section 1862(a)(1) of the Social Security Act.

Created on 09/28/2019. Page 3 of 33 The Section titled "Does the 'CPT 30% Rule' apply" needs clarification. This rule comes from the AMA (American Medical Association), the organization that holds the copyrights for all CPT codes. The rule states that if, in a given section (e.g., surgery) or subsection (e.g., surgery, integumentary) of the CPT Manual, more than 30% of the codes are listed in the LCD, then the short descriptors must be used rather than the long descriptors found in the CPT Manual.

This policy is subject to the reasonable and necessary guidelines and the limitation of liability provision.

This medical policy consolidates and replaces all previous policies and publications on this subject by Noridian and its predecessors for Medicare A/B.

Coding Information

CPT/HCPCS Codes

Group 1 Paragraph:

Use CPT 28899 for injection for Tarsal Tunnel Syndrome

Group 1 Codes:

CODE DESCRIPTION

20526 INJECTION, THERAPEUTIC (EG, LOCAL ANESTHETIC, CORTICOSTEROID), CARPAL TUNNEL

20527 INJECTION, ENZYME (EG, COLLAGENASE), PALMAR FASCIAL CORD (IE, DUPUYTREN'S CONTRACTURE)

20550 INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR "FASCIA")

20551 INJECTION(S); SINGLE TENDON ORIGIN/INSERTION

20612 ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION

26341 MANIPULATION, PALMAR FASCIAL CORD (IE, DUPUYTREN'S CORD), POST ENZYME INJECTION (EG, COLLAGENASE), SINGLE CORD

28899 UNLISTED PROCEDURE, FOOT OR TOES

64455 INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, PLANTAR COMMON DIGITAL NERVE(S) (EG, MORTON'S NEUROMA)

64632 DESTRUCTION BY NEUROLYTIC AGENT; PLANTAR COMMON DIGITAL NERVE

CPT/HCPCS Modifiers

Created on 09/28/2019. Page 4 of 33 N/A

ICD-10 Codes that Support Medical Necessity

Group 1 Paragraph:

Diagnosis codes are based on the current ICD-10-CM codes that are effective at the time of LCD publication. Any updates to ICD-10-CM codes will be reviewed by Noridian; and coverage should not be presumed until the results of such review have been published/posted.

These are the only covered ICD-10-CM codes That support medical necessity:

Group 1 Codes:

ICD-10 CODE DESCRIPTION

G56.01 Carpal tunnel syndrome, right upper limb

G56.02 Carpal tunnel syndrome, left upper limb

G56.03 Carpal tunnel syndrome, bilateral upper limbs

G57.51* Tarsal tunnel syndrome, right lower limb

G57.52* Tarsal tunnel syndrome, left lower limb

G57.53* Tarsal tunnel syndrome, bilateral lower limbs

G57.61* Lesion of plantar nerve, right lower limb

G57.62* Lesion of plantar nerve, left lower limb

G57.63* Lesion of plantar nerve, bilateral lower limbs

M24.211 Disorder of ligament, right shoulder

M24.212 Disorder of ligament, left shoulder

M24.221 Disorder of ligament, right elbow

M24.222 Disorder of ligament, left elbow

M24.231 Disorder of ligament, right wrist

M24.232 Disorder of ligament, left wrist

M24.241 Disorder of ligament, right hand

M24.242 Disorder of ligament, left hand

M24.251 Disorder of ligament, right hip

M24.252 Disorder of ligament, left hip

M24.271 Disorder of ligament, right ankle

M24.272 Disorder of ligament, left ankle

M24.274 Disorder of ligament, right foot

Created on 09/28/2019. Page 5 of 33 ICD-10 CODE DESCRIPTION

M24.275 Disorder of ligament, left foot

M53.3 Sacrococcygeal disorders, not elsewhere classified

M65.221 Calcific tendinitis, right upper arm

M65.222 Calcific tendinitis, left upper arm

M65.231 Calcific tendinitis, right forearm

M65.232 Calcific tendinitis, left forearm

M65.241 Calcific tendinitis, right hand

M65.242 Calcific tendinitis, left hand

M65.251 Calcific tendinitis, right thigh

M65.252 Calcific tendinitis, left thigh

M65.261 Calcific tendinitis, right lower leg

M65.262 Calcific tendinitis, left lower leg

M65.271 Calcific tendinitis, right ankle and foot

M65.272 Calcific tendinitis, left ankle and foot

M65.28 Calcific tendinitis, other site

M65.29 Calcific tendinitis, multiple sites

M65.311 Trigger thumb, right thumb

M65.312 Trigger thumb, left thumb

M65.321 Trigger finger, right index finger

M65.322 Trigger finger, left index finger

M65.331 Trigger finger, right middle finger

M65.332 Trigger finger, left middle finger

M65.341 Trigger finger, right ring finger

M65.342 Trigger finger, left ring finger

M65.351 Trigger finger, right little finger

M65.352 Trigger finger, left little finger

M65.4 Radial styloid tenosynovitis [de Quervain]

M65.811 Other synovitis and tenosynovitis, right shoulder

M65.812 Other synovitis and tenosynovitis, left shoulder

M65.821 Other synovitis and tenosynovitis, right upper arm

M65.822 Other synovitis and tenosynovitis, left upper arm

M65.831 Other synovitis and tenosynovitis, right forearm

Created on 09/28/2019. Page 6 of 33 ICD-10 CODE DESCRIPTION

M65.832 Other synovitis and tenosynovitis, left forearm

M65.841 Other synovitis and tenosynovitis, right hand

M65.842 Other synovitis and tenosynovitis, left hand

M65.851 Other synovitis and tenosynovitis, right thigh

M65.852 Other synovitis and tenosynovitis, left thigh

M65.861 Other synovitis and tenosynovitis, right lower leg

M65.862 Other synovitis and tenosynovitis, left lower leg

M65.871 Other synovitis and tenosynovitis, right ankle and foot

M65.872 Other synovitis and tenosynovitis, left ankle and foot

M65.88 Other synovitis and tenosynovitis, other site

M65.89 Other synovitis and tenosynovitis, multiple sites

M67.01 Short Achilles tendon (acquired), right ankle

M67.02 Short Achilles tendon (acquired), left ankle

M67.411 Ganglion, right shoulder

M67.412 Ganglion, left shoulder

M67.421 Ganglion, right elbow

M67.422 Ganglion, left elbow

M67.431 Ganglion, right wrist

M67.432 Ganglion, left wrist

M67.441 Ganglion, right hand

M67.442 Ganglion, left hand

M67.451 Ganglion, right hip

M67.452 Ganglion, left hip

M67.461 Ganglion, right knee

M67.462 Ganglion, left knee

M67.471 Ganglion, right ankle and foot

M67.472 Ganglion, left ankle and foot

M67.48 Ganglion, other site

M67.49 Ganglion, multiple sites

M67.51 Plica syndrome, right knee

M67.52 Plica syndrome, left knee

M67.813 Other specified disorders of tendon, right shoulder

Created on 09/28/2019. Page 7 of 33 ICD-10 CODE DESCRIPTION

M67.814 Other specified disorders of tendon, left shoulder

M67.823 Other specified disorders of tendon, right elbow

M67.824 Other specified disorders of tendon, left elbow

M67.833 Other specified disorders of tendon, right wrist

M67.834 Other specified disorders of tendon, left wrist

M67.843 Other specified disorders of tendon, right hand

M67.844 Other specified disorders of tendon, left hand

M67.853 Other specified disorders of tendon, right hip

M67.854 Other specified disorders of tendon, left hip

M67.863 Other specified disorders of tendon, right knee

M67.864 Other specified disorders of tendon, left knee

M67.873 Other specified disorders of tendon, right ankle and foot

M67.874 Other specified disorders of tendon, left ankle and foot

M67.88 Other specified disorders of synovium and tendon, other site

M67.89 Other specified disorders of synovium and tendon, multiple sites

ICD-10 CODE DESCRIPTION

M72.0* Palmar fascial fibromatosis [Dupuytren]

M72.2 Plantar fascial fibromatosis

M72.4 Pseudosarcomatous fibromatosis

M75.01 Adhesive capsulitis of right shoulder

M75.02 Adhesive capsulitis of left shoulder

M75.111 Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic

M75.112 Incomplete rotator cuff tear or rupture of left shoulder, not specified as traumatic

M75.21 Bicipital tendinitis, right shoulder

M75.22 Bicipital tendinitis, left shoulder

M75.31 Calcific tendinitis of right shoulder

M75.32 Calcific tendinitis of left shoulder

M75.41 Impingement syndrome of right shoulder

M75.42 Impingement syndrome of left shoulder

M75.81 Other shoulder lesions, right shoulder

M75.82 Other shoulder lesions, left shoulder

M76.01 Gluteal tendinitis, right hip

Created on 09/28/2019. Page 8 of 33 ICD-10 CODE DESCRIPTION

M76.02 Gluteal tendinitis, left hip

M76.11 Psoas tendinitis, right hip

M76.12 Psoas tendinitis, left hip

M76.21 Iliac crest spur, right hip

M76.22 Iliac crest spur, left hip

M76.31 Iliotibial band syndrome, right leg

M76.32 Iliotibial band syndrome, left leg

M76.51 Patellar tendinitis, right knee

M76.52 Patellar tendinitis, left knee

M76.61 Achilles tendinitis, right leg

M76.62 Achilles tendinitis, left leg

M76.71 Peroneal tendinitis, right leg

M76.72 Peroneal tendinitis, left leg

M76.811 Anterior tibial syndrome, right leg

M76.812 Anterior tibial syndrome, left leg

M76.821 Posterior tibial tendinitis, right leg

M76.822 Posterior tibial tendinitis, left leg

M76.891 Other specified enthesopathies of right lower limb, excluding foot

M76.892 Other specified enthesopathies of left lower limb, excluding foot

M77.01 Medial epicondylitis, right elbow

M77.02 Medial epicondylitis, left elbow

M77.11 Lateral epicondylitis, right elbow

M77.12 Lateral epicondylitis, left elbow

M77.21 Periarthritis, right wrist

M77.22 Periarthritis, left wrist

M77.31 Calcaneal spur, right foot

M77.32 Calcaneal spur, left foot

M77.41 Metatarsalgia, right foot

M77.42 Metatarsalgia, left foot

M77.51 Other enthesopathy of right foot and ankle

M77.52 Other enthesopathy of left foot and ankle

M77.8 Other enthesopathies, not elsewhere classified

Created on 09/28/2019. Page 9 of 33 ICD-10 CODE DESCRIPTION

S03.41XA Sprain of jaw, right side, initial encounter

S03.41XD Sprain of jaw, right side, subsequent encounter

S03.41XS Sprain of jaw, right side, sequela

S03.42XA Sprain of jaw, left side, initial encounter

S03.42XD Sprain of jaw, left side, subsequent encounter

S03.42XS Sprain of jaw, left side, sequela

S03.43XA Sprain of jaw, bilateral, initial encounter

S03.43XD Sprain of jaw, bilateral, subsequent encounter

S03.43XS Sprain of jaw, bilateral, sequela

S03.8XXA Sprain of joints and ligaments of other parts of head, initial encounter

S03.8XXD Sprain of joints and ligaments of other parts of head, subsequent encounter

S03.8XXS Sprain of joints and ligaments of other parts of head, sequela

S13.4XXA Sprain of ligaments of cervical spine, initial encounter

S13.4XXD Sprain of ligaments of cervical spine, subsequent encounter

S13.4XXS Sprain of ligaments of cervical spine, sequela

S13.8XXA Sprain of joints and ligaments of other parts of neck, initial encounter

S13.8XXD Sprain of joints and ligaments of other parts of neck, subsequent encounter

S13.8XXS Sprain of joints and ligaments of other parts of neck, sequela

S16.1XXA Strain of muscle, fascia and tendon at neck level, initial encounter

S16.1XXD Strain of muscle, fascia and tendon at neck level, subsequent encounter

S16.1XXS Strain of muscle, fascia and tendon at neck level, sequela

S23.3XXA Sprain of ligaments of thoracic spine, initial encounter

S23.3XXD Sprain of ligaments of thoracic spine, subsequent encounter

S23.3XXS Sprain of ligaments of thoracic spine, sequela

S23.41XA Sprain of ribs, initial encounter

S23.41XD Sprain of ribs, subsequent encounter

S23.41XS Sprain of ribs, sequela

S23.420A Sprain of sternoclavicular (joint) (ligament), initial encounter

S23.420D Sprain of sternoclavicular (joint) (ligament), subsequent encounter

S23.420S Sprain of sternoclavicular (joint) (ligament), sequela

S29.011A Strain of muscle and tendon of front wall of thorax, initial encounter

S29.011D Strain of muscle and tendon of front wall of thorax, subsequent encounter

Created on 09/28/2019. Page 10 of 33 ICD-10 CODE DESCRIPTION

S29.011S Strain of muscle and tendon of front wall of thorax, sequela

S29.012A Strain of muscle and tendon of back wall of thorax, initial encounter

S29.012D Strain of muscle and tendon of back wall of thorax, subsequent encounter

S29.012S Strain of muscle and tendon of back wall of thorax, sequela

S33.5XXA Sprain of ligaments of lumbar spine, initial encounter

S33.5XXD Sprain of ligaments of lumbar spine, subsequent encounter

S33.5XXS Sprain of ligaments of lumbar spine, sequela

S39.011A Strain of muscle, fascia and tendon of abdomen, initial encounter

S39.011D Strain of muscle, fascia and tendon of abdomen, subsequent encounter

S39.011S Strain of muscle, fascia and tendon of abdomen, sequela

S39.012A Strain of muscle, fascia and tendon of lower back, initial encounter

S39.012D Strain of muscle, fascia and tendon of lower back, subsequent encounter

S39.012S Strain of muscle, fascia and tendon of lower back, sequela

S39.013A Strain of muscle, fascia and tendon of pelvis, initial encounter

S39.013D Strain of muscle, fascia and tendon of pelvis, subsequent encounter

S39.013S Strain of muscle, fascia and tendon of pelvis, sequela

S43.411A Sprain of right coracohumeral (ligament), initial encounter

S43.411D Sprain of right coracohumeral (ligament), subsequent encounter

S43.411S Sprain of right coracohumeral (ligament), sequela

S43.412A Sprain of left coracohumeral (ligament), initial encounter

ICD-10 CODE DESCRIPTION

S43.412D Sprain of left coracohumeral (ligament), subsequent encounter

S43.412S Sprain of left coracohumeral (ligament), sequela

S43.421A Sprain of right rotator cuff capsule, initial encounter

S43.421D Sprain of right rotator cuff capsule, subsequent encounter

S43.421S Sprain of right rotator cuff capsule, sequela

S43.422A Sprain of left rotator cuff capsule, initial encounter

S43.422D Sprain of left rotator cuff capsule, subsequent encounter

S43.422S Sprain of left rotator cuff capsule, sequela

S43.81XA Sprain of other specified parts of right shoulder girdle, initial encounter

S43.81XD Sprain of other specified parts of right shoulder girdle, subsequent encounter

S43.81XS Sprain of other specified parts of right shoulder girdle, sequela

Created on 09/28/2019. Page 11 of 33 ICD-10 CODE DESCRIPTION

S43.82XA Sprain of other specified parts of left shoulder girdle, initial encounter

S43.82XD Sprain of other specified parts of left shoulder girdle, subsequent encounter

S43.82XS Sprain of other specified parts of left shoulder girdle, sequela

S46.011A Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial encounter

S46.011D Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, subsequent encounter

S46.011S Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, sequela

S46.012A Strain of muscle(s) and tendon(s) of the rotator cuff of left shoulder, initial encounter

S46.012D Strain of muscle(s) and tendon(s) of the rotator cuff of left shoulder, subsequent encounter

S46.012S Strain of muscle(s) and tendon(s) of the rotator cuff of left shoulder, sequela

S46.111A Strain of muscle, fascia and tendon of long head of biceps, right arm, initial encounter

S46.111D Strain of muscle, fascia and tendon of long head of biceps, right arm, subsequent encounter

S46.111S Strain of muscle, fascia and tendon of long head of biceps, right arm, sequela

S46.112A Strain of muscle, fascia and tendon of long head of biceps, left arm, initial encounter

S46.112D Strain of muscle, fascia and tendon of long head of biceps, left arm, subsequent encounter

S46.112S Strain of muscle, fascia and tendon of long head of biceps, left arm, sequela

S46.211A Strain of muscle, fascia and tendon of other parts of biceps, right arm, initial encounter

S46.211D Strain of muscle, fascia and tendon of other parts of biceps, right arm, subsequent encounter

S46.211S Strain of muscle, fascia and tendon of other parts of biceps, right arm, sequela

S46.212A Strain of muscle, fascia and tendon of other parts of biceps, left arm, initial encounter

S46.212D Strain of muscle, fascia and tendon of other parts of biceps, left arm, subsequent encounter

S46.212S Strain of muscle, fascia and tendon of other parts of biceps, left arm, sequela

S46.311A Strain of muscle, fascia and tendon of triceps, right arm, initial encounter

S46.311D Strain of muscle, fascia and tendon of triceps, right arm, subsequent encounter

S46.311S Strain of muscle, fascia and tendon of triceps, right arm, sequela

Created on 09/28/2019. Page 12 of 33 ICD-10 CODE DESCRIPTION

S46.312A Strain of muscle, fascia and tendon of triceps, left arm, initial encounter

S46.312D Strain of muscle, fascia and tendon of triceps, left arm, subsequent encounter

S46.312S Strain of muscle, fascia and tendon of triceps, left arm, sequela

S46.811A Strain of other muscles, fascia and tendons at shoulder and upper arm level, right arm, initial encounter

S46.811D Strain of other muscles, fascia and tendons at shoulder and upper arm level, right arm, subsequent encounter

S46.811S Strain of other muscles, fascia and tendons at shoulder and upper arm level, right arm, sequela

S46.812A Strain of other muscles, fascia and tendons at shoulder and upper arm level, left arm, initial encounter

S46.812D Strain of other muscles, fascia and tendons at shoulder and upper arm level, left arm, subsequent encounter

S46.812S Strain of other muscles, fascia and tendons at shoulder and upper arm level, left arm, sequela

S53.431A Radial collateral ligament sprain of right elbow, initial encounter

S53.431D Radial collateral ligament sprain of right elbow, subsequent encounter

S53.431S Radial collateral ligament sprain of right elbow, sequela

S53.432A Radial collateral ligament sprain of left elbow, initial encounter

S53.432D Radial collateral ligament sprain of left elbow, subsequent encounter

S53.432S Radial collateral ligament sprain of left elbow, sequela

S53.441A Ulnar collateral ligament sprain of right elbow, initial encounter

S53.441D Ulnar collateral ligament sprain of right elbow, subsequent encounter

S53.441S Ulnar collateral ligament sprain of right elbow, sequela

S53.442A Ulnar collateral ligament sprain of left elbow, initial encounter

S53.442D Ulnar collateral ligament sprain of left elbow, subsequent encounter

S53.442S Ulnar collateral ligament sprain of left elbow, sequela

S53.491A Other sprain of right elbow, initial encounter

S53.491D Other sprain of right elbow, subsequent encounter

S53.491S Other sprain of right elbow, sequela

S53.492A Other sprain of left elbow, initial encounter

S53.492D Other sprain of left elbow, subsequent encounter

S53.492S Other sprain of left elbow, sequela

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S56.011A Strain of flexor muscle, fascia and tendon of right thumb at forearm level, initial encounter

S56.011D Strain of flexor muscle, fascia and tendon of right thumb at forearm level, subsequent encounter

S56.011S Strain of flexor muscle, fascia and tendon of right thumb at forearm level, sequela

S56.012A Strain of flexor muscle, fascia and tendon of left thumb at forearm level, initial encounter

S56.012D Strain of flexor muscle, fascia and tendon of left thumb at forearm level, subsequent encounter

S56.012S Strain of flexor muscle, fascia and tendon of left thumb at forearm level, sequela

S56.111A Strain of flexor muscle, fascia and tendon of right index finger at forearm level, initial encounter

S56.111D Strain of flexor muscle, fascia and tendon of right index finger at forearm level, subsequent encounter

S56.111S Strain of flexor muscle, fascia and tendon of right index finger at forearm level, sequela

S56.112A Strain of flexor muscle, fascia and tendon of left index finger at forearm level, initial encounter

S56.112D Strain of flexor muscle, fascia and tendon of left index finger at forearm level, subsequent encounter

S56.112S Strain of flexor muscle, fascia and tendon of left index finger at forearm level, sequela

S56.113A Strain of flexor muscle, fascia and tendon of right middle finger at forearm level, initial encounter

S56.113D Strain of flexor muscle, fascia and tendon of right middle finger at forearm level, subsequent encounter

S56.113S Strain of flexor muscle, fascia and tendon of right middle finger at forearm level, sequela

S56.114A Strain of flexor muscle, fascia and tendon of left middle finger at forearm level, initial encounter

S56.114D Strain of flexor muscle, fascia and tendon of left middle finger at forearm level, subsequent encounter

S56.114S Strain of flexor muscle, fascia and tendon of left middle finger at forearm level, sequela

S56.115A Strain of flexor muscle, fascia and tendon of right ring finger at forearm level, initial encounter

S56.115D Strain of flexor muscle, fascia and tendon of right ring finger at forearm level,

Created on 09/28/2019. Page 14 of 33 ICD-10 CODE DESCRIPTION

subsequent encounter

S56.115S Strain of flexor muscle, fascia and tendon of right ring finger at forearm level, sequela

S56.116A Strain of flexor muscle, fascia and tendon of left ring finger at forearm level, initial encounter

S56.116D Strain of flexor muscle, fascia and tendon of left ring finger at forearm level, subsequent encounter

S56.116S Strain of flexor muscle, fascia and tendon of left ring finger at forearm level, sequela

S56.117A Strain of flexor muscle, fascia and tendon of right little finger at forearm level, initial encounter

S56.117D Strain of flexor muscle, fascia and tendon of right little finger at forearm level, subsequent encounter

S56.117S Strain of flexor muscle, fascia and tendon of right little finger at forearm level, sequela

S56.118A Strain of flexor muscle, fascia and tendon of left little finger at forearm level, initial encounter

S56.118D Strain of flexor muscle, fascia and tendon of left little finger at forearm level, subsequent encounter

S56.118S Strain of flexor muscle, fascia and tendon of left little finger at forearm level, sequela

S56.211A Strain of other flexor muscle, fascia and tendon at forearm level, right arm, initial encounter

S56.211D Strain of other flexor muscle, fascia and tendon at forearm level, right arm, subsequent encounter

S56.211S Strain of other flexor muscle, fascia and tendon at forearm level, right arm, sequela

S56.212A Strain of other flexor muscle, fascia and tendon at forearm level, left arm, initial encounter

S56.212D Strain of other flexor muscle, fascia and tendon at forearm level, left arm, subsequent encounter

S56.212S Strain of other flexor muscle, fascia and tendon at forearm level, left arm, sequela

S56.311A Strain of extensor or abductor muscles, fascia and tendons of right thumb at forearm level, initial encounter

S56.311D Strain of extensor or abductor muscles, fascia and tendons of right thumb at forearm level, subsequent encounter

ICD-10 CODE DESCRIPTION

S56.311S Strain of extensor or abductor muscles, fascia and tendons of right thumb at

Created on 09/28/2019. Page 15 of 33 ICD-10 CODE DESCRIPTION

forearm level, sequela

S56.312A Strain of extensor or abductor muscles, fascia and tendons of left thumb at forearm level, initial encounter

S56.312D Strain of extensor or abductor muscles, fascia and tendons of left thumb at forearm level, subsequent encounter

S56.312S Strain of extensor or abductor muscles, fascia and tendons of left thumb at forearm level, sequela

S56.411A Strain of extensor muscle, fascia and tendon of right index finger at forearm level, initial encounter

S56.411D Strain of extensor muscle, fascia and tendon of right index finger at forearm level, subsequent encounter

S56.411S Strain of extensor muscle, fascia and tendon of right index finger at forearm level, sequela

S56.412A Strain of extensor muscle, fascia and tendon of left index finger at forearm level, initial encounter

S56.412D Strain of extensor muscle, fascia and tendon of left index finger at forearm level, subsequent encounter

S56.412S Strain of extensor muscle, fascia and tendon of left index finger at forearm level, sequela

S56.413A Strain of extensor muscle, fascia and tendon of right middle finger at forearm level, initial encounter

S56.413D Strain of extensor muscle, fascia and tendon of right middle finger at forearm level, subsequent encounter

S56.413S Strain of extensor muscle, fascia and tendon of right middle finger at forearm level, sequela

S56.414A Strain of extensor muscle, fascia and tendon of left middle finger at forearm level, initial encounter

S56.414D Strain of extensor muscle, fascia and tendon of left middle finger at forearm level, subsequent encounter

S56.414S Strain of extensor muscle, fascia and tendon of left middle finger at forearm level, sequela

S56.415A Strain of extensor muscle, fascia and tendon of right ring finger at forearm level, initial encounter

S56.415D Strain of extensor muscle, fascia and tendon of right ring finger at forearm level, subsequent encounter

S56.415S Strain of extensor muscle, fascia and tendon of right ring finger at forearm level, sequela

Created on 09/28/2019. Page 16 of 33 ICD-10 CODE DESCRIPTION

S56.416A Strain of extensor muscle, fascia and tendon of left ring finger at forearm level, initial encounter

S56.416D Strain of extensor muscle, fascia and tendon of left ring finger at forearm level, subsequent encounter

S56.416S Strain of extensor muscle, fascia and tendon of left ring finger at forearm level, sequela

S56.417A Strain of extensor muscle, fascia and tendon of right little finger at forearm level, initial encounter

S56.417D Strain of extensor muscle, fascia and tendon of right little finger at forearm level, subsequent encounter

S56.417S Strain of extensor muscle, fascia and tendon of right little finger at forearm level, sequela

S56.418A Strain of extensor muscle, fascia and tendon of left little finger at forearm level, initial encounter

S56.418D Strain of extensor muscle, fascia and tendon of left little finger at forearm level, subsequent encounter

S56.418S Strain of extensor muscle, fascia and tendon of left little finger at forearm level, sequela

S56.511A Strain of other extensor muscle, fascia and tendon at forearm level, right arm, initial encounter

S56.511D Strain of other extensor muscle, fascia and tendon at forearm level, right arm, subsequent encounter

S56.511S Strain of other extensor muscle, fascia and tendon at forearm level, right arm, sequela

S56.512A Strain of other extensor muscle, fascia and tendon at forearm level, left arm, initial encounter

S56.512D Strain of other extensor muscle, fascia and tendon at forearm level, left arm, subsequent encounter

S56.512S Strain of other extensor muscle, fascia and tendon at forearm level, left arm, sequela

S56.811A Strain of other muscles, fascia and tendons at forearm level, right arm, initial encounter

S56.811D Strain of other muscles, fascia and tendons at forearm level, right arm, subsequent encounter

S56.811S Strain of other muscles, fascia and tendons at forearm level, right arm, sequela

S56.812A Strain of other muscles, fascia and tendons at forearm level, left arm, initial encounter

Created on 09/28/2019. Page 17 of 33 ICD-10 CODE DESCRIPTION

S56.812D Strain of other muscles, fascia and tendons at forearm level, left arm, subsequent encounter

S56.812S Strain of other muscles, fascia and tendons at forearm level, left arm, sequela

S63.591A Other specified sprain of right wrist, initial encounter

S63.591D Other specified sprain of right wrist, subsequent encounter

S63.591S Other specified sprain of right wrist, sequela

S63.592A Other specified sprain of left wrist, initial encounter

S63.592D Other specified sprain of left wrist, subsequent encounter

S63.592S Other specified sprain of left wrist, sequela

S63.681A Other sprain of right thumb, initial encounter

S63.681D Other sprain of right thumb, subsequent encounter

S63.681S Other sprain of right thumb, sequela

S63.682A Other sprain of left thumb, initial encounter

S63.682D Other sprain of left thumb, subsequent encounter

S63.682S Other sprain of left thumb, sequela

S63.690A Other sprain of right index finger, initial encounter

S63.690D Other sprain of right index finger, subsequent encounter

S63.690S Other sprain of right index finger, sequela

S63.691A Other sprain of left index finger, initial encounter

S63.691D Other sprain of left index finger, subsequent encounter

S63.691S Other sprain of left index finger, sequela

S63.692A Other sprain of right middle finger, initial encounter

S63.692D Other sprain of right middle finger, subsequent encounter

S63.692S Other sprain of right middle finger, sequela

S63.693A Other sprain of left middle finger, initial encounter

S63.693D Other sprain of left middle finger, subsequent encounter

S63.693S Other sprain of left middle finger, sequela

S63.694A Other sprain of right ring finger, initial encounter

S63.694D Other sprain of right ring finger, subsequent encounter

S63.694S Other sprain of right ring finger, sequela

S63.695A Other sprain of left ring finger, initial encounter

S63.695D Other sprain of left ring finger, subsequent encounter

Created on 09/28/2019. Page 18 of 33 ICD-10 CODE DESCRIPTION

S63.695S Other sprain of left ring finger, sequela

S63.696A Other sprain of right little finger, initial encounter

S63.696D Other sprain of right little finger, subsequent encounter

S63.696S Other sprain of right little finger, sequela

S63.697A Other sprain of left little finger, initial encounter

S63.697D Other sprain of left little finger, subsequent encounter

S63.697S Other sprain of left little finger, sequela

S63.8X1A Sprain of other part of right wrist and hand, initial encounter

S63.8X1D Sprain of other part of right wrist and hand, subsequent encounter

S63.8X1S Sprain of other part of right wrist and hand, sequela

S63.8X2A Sprain of other part of left wrist and hand, initial encounter

S63.8X2D Sprain of other part of left wrist and hand, subsequent encounter

S63.8X2S Sprain of other part of left wrist and hand, sequela

S66.011A Strain of long flexor muscle, fascia and tendon of right thumb at wrist and hand level, initial encounter

S66.011D Strain of long flexor muscle, fascia and tendon of right thumb at wrist and hand level, subsequent encounter

S66.011S Strain of long flexor muscle, fascia and tendon of right thumb at wrist and hand level, sequela

S66.012A Strain of long flexor muscle, fascia and tendon of left thumb at wrist and hand level, initial encounter

S66.012D Strain of long flexor muscle, fascia and tendon of left thumb at wrist and hand level, subsequent encounter

S66.012S Strain of long flexor muscle, fascia and tendon of left thumb at wrist and hand level, sequela

S66.110A Strain of flexor muscle, fascia and tendon of right index finger at wrist and hand level, initial encounter

S66.110D Strain of flexor muscle, fascia and tendon of right index finger at wrist and hand level, subsequent encounter

S66.110S Strain of flexor muscle, fascia and tendon of right index finger at wrist and hand level, sequela

S66.111A Strain of flexor muscle, fascia and tendon of left index finger at wrist and hand level, initial encounter

S66.111D Strain of flexor muscle, fascia and tendon of left index finger at wrist and hand level, subsequent encounter

Created on 09/28/2019. Page 19 of 33 ICD-10 CODE DESCRIPTION

S66.111S Strain of flexor muscle, fascia and tendon of left index finger at wrist and hand level, sequela

S66.112A Strain of flexor muscle, fascia and tendon of right middle finger at wrist and hand level, initial encounter

S66.112D Strain of flexor muscle, fascia and tendon of right middle finger at wrist and hand level, subsequent encounter

S66.112S Strain of flexor muscle, fascia and tendon of right middle finger at wrist and hand level, sequela

S66.113A Strain of flexor muscle, fascia and tendon of left middle finger at wrist and hand level, initial encounter

S66.113D Strain of flexor muscle, fascia and tendon of left middle finger at wrist and hand level, subsequent encounter

S66.113S Strain of flexor muscle, fascia and tendon of left middle finger at wrist and hand level, sequela

ICD-10 CODE DESCRIPTION

S66.114A Strain of flexor muscle, fascia and tendon of right ring finger at wrist and hand level, initial encounter

S66.114D Strain of flexor muscle, fascia and tendon of right ring finger at wrist and hand level, subsequent encounter

S66.114S Strain of flexor muscle, fascia and tendon of right ring finger at wrist and hand level, sequela

S66.115A Strain of flexor muscle, fascia and tendon of left ring finger at wrist and hand level, initial encounter

S66.115D Strain of flexor muscle, fascia and tendon of left ring finger at wrist and hand level, subsequent encounter

S66.115S Strain of flexor muscle, fascia and tendon of left ring finger at wrist and hand level, sequela

S66.116A Strain of flexor muscle, fascia and tendon of right little finger at wrist and hand level, initial encounter

S66.116D Strain of flexor muscle, fascia and tendon of right little finger at wrist and hand level, subsequent encounter

S66.116S Strain of flexor muscle, fascia and tendon of right little finger at wrist and hand level, sequela

S66.117A Strain of flexor muscle, fascia and tendon of left little finger at wrist and hand level, initial encounter

S66.117D Strain of flexor muscle, fascia and tendon of left little finger at wrist and hand level, subsequent encounter

Created on 09/28/2019. Page 20 of 33 ICD-10 CODE DESCRIPTION

S66.117S Strain of flexor muscle, fascia and tendon of left little finger at wrist and hand level, sequela

S66.211A Strain of extensor muscle, fascia and tendon of right thumb at wrist and hand level, initial encounter

S66.211D Strain of extensor muscle, fascia and tendon of right thumb at wrist and hand level, subsequent encounter

S66.211S Strain of extensor muscle, fascia and tendon of right thumb at wrist and hand level, sequela

S66.212A Strain of extensor muscle, fascia and tendon of left thumb at wrist and hand level, initial encounter

S66.212D Strain of extensor muscle, fascia and tendon of left thumb at wrist and hand level, subsequent encounter

S66.212S Strain of extensor muscle, fascia and tendon of left thumb at wrist and hand level, sequela

S66.310A Strain of extensor muscle, fascia and tendon of right index finger at wrist and hand level, initial encounter

S66.310D Strain of extensor muscle, fascia and tendon of right index finger at wrist and hand level, subsequent encounter

S66.310S Strain of extensor muscle, fascia and tendon of right index finger at wrist and hand level, sequela

S66.311A Strain of extensor muscle, fascia and tendon of left index finger at wrist and hand level, initial encounter

S66.311D Strain of extensor muscle, fascia and tendon of left index finger at wrist and hand level, subsequent encounter

S66.311S Strain of extensor muscle, fascia and tendon of left index finger at wrist and hand level, sequela

S66.312A Strain of extensor muscle, fascia and tendon of right middle finger at wrist and hand level, initial encounter

S66.312D Strain of extensor muscle, fascia and tendon of right middle finger at wrist and hand level, subsequent encounter

S66.312S Strain of extensor muscle, fascia and tendon of right middle finger at wrist and hand level, sequela

S66.313A Strain of extensor muscle, fascia and tendon of left middle finger at wrist and hand level, initial encounter

S66.313D Strain of extensor muscle, fascia and tendon of left middle finger at wrist and hand level, subsequent encounter

S66.313S Strain of extensor muscle, fascia and tendon of left middle finger at wrist and hand

Created on 09/28/2019. Page 21 of 33 ICD-10 CODE DESCRIPTION

level, sequela

S66.314A Strain of extensor muscle, fascia and tendon of right ring finger at wrist and hand level, initial encounter

S66.314D Strain of extensor muscle, fascia and tendon of right ring finger at wrist and hand level, subsequent encounter

S66.314S Strain of extensor muscle, fascia and tendon of right ring finger at wrist and hand level, sequela

S66.315A Strain of extensor muscle, fascia and tendon of left ring finger at wrist and hand level, initial encounter

S66.315D Strain of extensor muscle, fascia and tendon of left ring finger at wrist and hand level, subsequent encounter

S66.315S Strain of extensor muscle, fascia and tendon of left ring finger at wrist and hand level, sequela

S66.316A Strain of extensor muscle, fascia and tendon of right little finger at wrist and hand level, initial encounter

S66.316D Strain of extensor muscle, fascia and tendon of right little finger at wrist and hand level, subsequent encounter

S66.316S Strain of extensor muscle, fascia and tendon of right little finger at wrist and hand level, sequela

S66.317A Strain of extensor muscle, fascia and tendon of left little finger at wrist and hand level, initial encounter

S66.317D Strain of extensor muscle, fascia and tendon of left little finger at wrist and hand level, subsequent encounter

S66.317S Strain of extensor muscle, fascia and tendon of left little finger at wrist and hand level, sequela

S66.411A Strain of intrinsic muscle, fascia and tendon of right thumb at wrist and hand level, initial encounter

S66.411D Strain of intrinsic muscle, fascia and tendon of right thumb at wrist and hand level, subsequent encounter

S66.411S Strain of intrinsic muscle, fascia and tendon of right thumb at wrist and hand level, sequela

S66.412A Strain of intrinsic muscle, fascia and tendon of left thumb at wrist and hand level, initial encounter

S66.412D Strain of intrinsic muscle, fascia and tendon of left thumb at wrist and hand level, subsequent encounter

S66.412S Strain of intrinsic muscle, fascia and tendon of left thumb at wrist and hand level, sequela

Created on 09/28/2019. Page 22 of 33 ICD-10 CODE DESCRIPTION

S66.510A Strain of intrinsic muscle, fascia and tendon of right index finger at wrist and hand level, initial encounter

S66.510D Strain of intrinsic muscle, fascia and tendon of right index finger at wrist and hand level, subsequent encounter

S66.510S Strain of intrinsic muscle, fascia and tendon of right index finger at wrist and hand level, sequela

S66.511A Strain of intrinsic muscle, fascia and tendon of left index finger at wrist and hand level, initial encounter

S66.511D Strain of intrinsic muscle, fascia and tendon of left index finger at wrist and hand level, subsequent encounter

S66.511S Strain of intrinsic muscle, fascia and tendon of left index finger at wrist and hand level, sequela

S66.512A Strain of intrinsic muscle, fascia and tendon of right middle finger at wrist and hand level, initial encounter

S66.512D Strain of intrinsic muscle, fascia and tendon of right middle finger at wrist and hand level, subsequent encounter

S66.512S Strain of intrinsic muscle, fascia and tendon of right middle finger at wrist and hand level, sequela

S66.513A Strain of intrinsic muscle, fascia and tendon of left middle finger at wrist and hand level, initial encounter

S66.513D Strain of intrinsic muscle, fascia and tendon of left middle finger at wrist and hand level, subsequent encounter

S66.513S Strain of intrinsic muscle, fascia and tendon of left middle finger at wrist and hand level, sequela

S66.514A Strain of intrinsic muscle, fascia and tendon of right ring finger at wrist and hand level, initial encounter

S66.514D Strain of intrinsic muscle, fascia and tendon of right ring finger at wrist and hand level, subsequent encounter

S66.514S Strain of intrinsic muscle, fascia and tendon of right ring finger at wrist and hand level, sequela

S66.515A Strain of intrinsic muscle, fascia and tendon of left ring finger at wrist and hand level, initial encounter

S66.515D Strain of intrinsic muscle, fascia and tendon of left ring finger at wrist and hand level, subsequent encounter

S66.515S Strain of intrinsic muscle, fascia and tendon of left ring finger at wrist and hand level, sequela

S66.516A Strain of intrinsic muscle, fascia and tendon of right little finger at wrist and hand

Created on 09/28/2019. Page 23 of 33 ICD-10 CODE DESCRIPTION

level, initial encounter

S66.516D Strain of intrinsic muscle, fascia and tendon of right little finger at wrist and hand level, subsequent encounter

S66.516S Strain of intrinsic muscle, fascia and tendon of right little finger at wrist and hand level, sequela

S66.517A Strain of intrinsic muscle, fascia and tendon of left little finger at wrist and hand level, initial encounter

S66.517D Strain of intrinsic muscle, fascia and tendon of left little finger at wrist and hand level, subsequent encounter

S66.517S Strain of intrinsic muscle, fascia and tendon of left little finger at wrist and hand level, sequela

S66.811A Strain of other specified muscles, fascia and tendons at wrist and hand level, right hand, initial encounter

S66.811D Strain of other specified muscles, fascia and tendons at wrist and hand level, right hand, subsequent encounter

S66.811S Strain of other specified muscles, fascia and tendons at wrist and hand level, right hand, sequela

S66.812A Strain of other specified muscles, fascia and tendons at wrist and hand level, left hand, initial encounter

S66.812D Strain of other specified muscles, fascia and tendons at wrist and hand level, left hand, subsequent encounter

S66.812S Strain of other specified muscles, fascia and tendons at wrist and hand level, left hand, sequela

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

S73.112A 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

S73.121A 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

S73.122A 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

Created on 09/28/2019. Page 24 of 33 ICD-10 CODE DESCRIPTION

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

S73.192A Other sprain of left hip, initial encounter

S73.192D Other sprain of left hip, subsequent encounter

S73.192S Other sprain of left hip, sequela

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

S76.012A Strain of muscle, fascia and tendon of left hip, initial encounter

ICD-10 CODE DESCRIPTION

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

S76.111A Strain of right quadriceps muscle, fascia and tendon, initial encounter

S76.111D Strain of right quadriceps muscle, fascia and tendon, subsequent encounter

S76.111S Strain of right quadriceps muscle, fascia and tendon, sequela

S76.112A Strain of left quadriceps muscle, fascia and tendon, initial encounter

S76.112D Strain of left quadriceps muscle, fascia and tendon, subsequent encounter

S76.112S Strain of left quadriceps muscle, fascia and tendon, sequela

S76.211A Strain of adductor muscle, fascia and tendon of right thigh, initial encounter

S76.211D Strain of adductor muscle, fascia and tendon of right thigh, subsequent encounter

S76.211S Strain of adductor muscle, fascia and tendon of right thigh, sequela

S76.212A Strain of adductor muscle, fascia and tendon of left thigh, initial encounter

S76.212D Strain of adductor muscle, fascia and tendon of left thigh, subsequent encounter

S76.212S Strain of adductor muscle, fascia and tendon of left thigh, sequela

S76.311A Strain of muscle, fascia and tendon of the posterior muscle group at thigh level, right thigh, initial encounter

S76.311D Strain of muscle, fascia and tendon of the posterior muscle group at thigh level, right thigh, subsequent encounter

S76.311S Strain of muscle, fascia and tendon of the posterior muscle group at thigh level, right thigh, sequela

S76.312A Strain of muscle, fascia and tendon of the posterior muscle group at thigh level, left thigh, initial encounter

Created on 09/28/2019. Page 25 of 33 ICD-10 CODE DESCRIPTION

S76.312D Strain of muscle, fascia and tendon of the posterior muscle group at thigh level, left thigh, subsequent encounter

S76.312S Strain of muscle, fascia and tendon of the posterior muscle group at thigh level, left thigh, sequela

S76.811A Strain of other specified muscles, fascia and tendons at thigh level, right thigh, initial encounter

S76.811D Strain of other specified muscles, fascia and tendons at thigh level, right thigh, subsequent encounter

S76.811S Strain of other specified muscles, fascia and tendons at thigh level, right thigh, sequela

S76.812A Strain of other specified muscles, fascia and tendons at thigh level, left thigh, initial encounter

S76.812D Strain of other specified muscles, fascia and tendons at thigh level, left thigh, subsequent encounter

S76.812S Strain of other specified muscles, fascia and tendons at thigh level, left thigh, sequela

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

S83.412A 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

S83.421A Sprain of lateral collateral ligament of right knee, initial encounter

S83.421D Sprain of lateral collateral ligament of right knee, subsequent encounter

S83.421S Sprain of lateral collateral ligament of right knee, sequela

S83.422A Sprain of lateral collateral ligament of left knee, initial encounter

S83.422D Sprain of lateral collateral ligament of left knee, subsequent encounter

S83.422S Sprain of lateral collateral ligament of left knee, sequela

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

S83.512A 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

Created on 09/28/2019. Page 26 of 33 ICD-10 CODE DESCRIPTION

S83.521A Sprain of posterior cruciate ligament of right knee, initial encounter

S83.521D Sprain of posterior cruciate ligament of right knee, subsequent encounter

S83.521S Sprain of posterior cruciate ligament of right knee, sequela

S83.522A Sprain of posterior cruciate ligament of left knee, initial encounter

S83.522D Sprain of posterior cruciate ligament of left knee, subsequent encounter

S83.522S Sprain of posterior cruciate ligament of left knee, sequela

S83.61XA Sprain of the superior tibiofibular joint and ligament, right knee, initial encounter

S83.61XD Sprain of the superior tibiofibular joint and ligament, right knee, subsequent encounter

S83.61XS Sprain of the superior tibiofibular joint and ligament, right knee, sequela

S83.62XA Sprain of the superior tibiofibular joint and ligament, left knee, initial encounter

S83.62XD Sprain of the superior tibiofibular joint and ligament, left knee, subsequent encounter

S83.62XS Sprain of the superior tibiofibular joint and ligament, left knee, sequela

S83.8X1A Sprain of other specified parts of right knee, initial encounter

S83.8X1D Sprain of other specified parts of right knee, subsequent encounter

S83.8X1S Sprain of other specified parts of right knee, sequela

S83.8X2A Sprain of other specified parts of left knee, initial encounter

S83.8X2D Sprain of other specified parts of left knee, subsequent encounter

S83.8X2S Sprain of other specified parts of left knee, sequela

S86.011A Strain of right Achilles tendon, initial encounter

S86.011D Strain of right Achilles tendon, subsequent encounter

S86.011S Strain of right Achilles tendon, sequela

S86.012A Strain of left Achilles tendon, initial encounter

S86.012D Strain of left Achilles tendon, subsequent encounter

S86.012S Strain of left Achilles tendon, sequela

S86.111A Strain of other muscle(s) and tendon(s) of posterior muscle group at lower leg level, right leg, initial encounter

S86.111D Strain of other muscle(s) and tendon(s) of posterior muscle group at lower leg level, right leg, subsequent encounter

S86.111S Strain of other muscle(s) and tendon(s) of posterior muscle group at lower leg level, right leg, sequela

S86.112A Strain of other muscle(s) and tendon(s) of posterior muscle group at lower leg level,

Created on 09/28/2019. Page 27 of 33 ICD-10 CODE DESCRIPTION

left leg, initial encounter

S86.112D Strain of other muscle(s) and tendon(s) of posterior muscle group at lower leg level, left leg, subsequent encounter

S86.112S Strain of other muscle(s) and tendon(s) of posterior muscle group at lower leg level, left leg, sequela

S86.211A Strain of muscle(s) and tendon(s) of anterior muscle group at lower leg level, right leg, initial encounter

S86.211D Strain of muscle(s) and tendon(s) of anterior muscle group at lower leg level, right leg, subsequent encounter

S86.211S Strain of muscle(s) and tendon(s) of anterior muscle group at lower leg level, right leg, sequela

S86.212A Strain of muscle(s) and tendon(s) of anterior muscle group at lower leg level, left leg, initial encounter

S86.212D Strain of muscle(s) and tendon(s) of anterior muscle group at lower leg level, left leg, subsequent encounter

S86.212S Strain of muscle(s) and tendon(s) of anterior muscle group at lower leg level, left leg, sequela

S86.311A Strain of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, right leg, initial encounter

S86.311D Strain of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, right leg, subsequent encounter

S86.311S Strain of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, right leg, sequela

S86.312A Strain of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, left leg, initial encounter

S86.312D Strain of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, left leg, subsequent encounter

S86.312S Strain of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, left leg, sequela

S86.811A Strain of other muscle(s) and tendon(s) at lower leg level, right leg, initial encounter

S86.811D Strain of other muscle(s) and tendon(s) at lower leg level, right leg, subsequent encounter

S86.811S Strain of other muscle(s) and tendon(s) at lower leg level, right leg, sequela

S86.812A Strain of other muscle(s) and tendon(s) at lower leg level, left leg, initial encounter

S86.812D Strain of other muscle(s) and tendon(s) at lower leg level, left leg, subsequent encounter

Created on 09/28/2019. Page 28 of 33 ICD-10 CODE DESCRIPTION

S86.812S Strain of other muscle(s) and tendon(s) at lower leg level, left leg, sequela

S93.411A Sprain of calcaneofibular ligament of right ankle, initial encounter

S93.411D Sprain of calcaneofibular ligament of right ankle, subsequent encounter

S93.411S Sprain of calcaneofibular ligament of right ankle, sequela

S93.412A Sprain of calcaneofibular ligament of left ankle, initial encounter

S93.412D Sprain of calcaneofibular ligament of left ankle, subsequent encounter

S93.412S Sprain of calcaneofibular ligament of left ankle, sequela

S93.421A Sprain of deltoid ligament of right ankle, initial encounter

S93.421D Sprain of deltoid ligament of right ankle, subsequent encounter

ICD-10 CODE DESCRIPTION

S93.421S Sprain of deltoid ligament of right ankle, sequela

S93.422A Sprain of deltoid ligament of left ankle, initial encounter

S93.422D Sprain of deltoid ligament of left ankle, subsequent encounter

S93.422S Sprain of deltoid ligament of left ankle, sequela

S93.431A Sprain of tibiofibular ligament of right ankle, initial encounter

S93.431D Sprain of tibiofibular ligament of right ankle, subsequent encounter

S93.431S Sprain of tibiofibular ligament of right ankle, sequela

S93.432A Sprain of tibiofibular ligament of left ankle, initial encounter

S93.432D Sprain of tibiofibular ligament of left ankle, subsequent encounter

S93.432S Sprain of tibiofibular ligament of left ankle, sequela

S93.491A Sprain of other ligament of right ankle, initial encounter

S93.491D Sprain of other ligament of right ankle, subsequent encounter

S93.491S Sprain of other ligament of right ankle, sequela

S93.492A Sprain of other ligament of left ankle, initial encounter

S93.492D Sprain of other ligament of left ankle, subsequent encounter

S93.492S Sprain of other ligament of left ankle, sequela

S93.611A Sprain of tarsal ligament of right foot, initial encounter

S93.611D Sprain of tarsal ligament of right foot, subsequent encounter

S93.611S Sprain of tarsal ligament of right foot, sequela

S93.612A Sprain of tarsal ligament of left foot, initial encounter

S93.612D Sprain of tarsal ligament of left foot, subsequent encounter

S93.612S Sprain of tarsal ligament of left foot, sequela

Created on 09/28/2019. Page 29 of 33 ICD-10 CODE DESCRIPTION

S93.621A Sprain of tarsometatarsal ligament of right foot, initial encounter

S93.621D Sprain of tarsometatarsal ligament of right foot, subsequent encounter

S93.621S Sprain of tarsometatarsal ligament of right foot, sequela

S93.622A Sprain of tarsometatarsal ligament of left foot, initial encounter

S93.622D Sprain of tarsometatarsal ligament of left foot, subsequent encounter

S93.622S Sprain of tarsometatarsal ligament of left foot, sequela

S93.691A Other sprain of right foot, initial encounter

S93.691D Other sprain of right foot, subsequent encounter

S93.691S Other sprain of right foot, sequela

S93.692A Other sprain of left foot, initial encounter

S93.692D Other sprain of left foot, subsequent encounter

S93.692S Other sprain of left foot, sequela

S96.011A Strain of muscle and tendon of long flexor muscle of toe at ankle and foot level, right foot, initial encounter

S96.011D Strain of muscle and tendon of long flexor muscle of toe at ankle and foot level, right foot, subsequent encounter

S96.011S Strain of muscle and tendon of long flexor muscle of toe at ankle and foot level, right foot, sequela

S96.012A Strain of muscle and tendon of long flexor muscle of toe at ankle and foot level, left foot, initial encounter

S96.012D Strain of muscle and tendon of long flexor muscle of toe at ankle and foot level, left foot, subsequent encounter

S96.012S Strain of muscle and tendon of long flexor muscle of toe at ankle and foot level, left foot, sequela

S96.111A Strain of muscle and tendon of long extensor muscle of toe at ankle and foot level, right foot, initial encounter

S96.111D Strain of muscle and tendon of long extensor muscle of toe at ankle and foot level, right foot, subsequent encounter

S96.111S Strain of muscle and tendon of long extensor muscle of toe at ankle and foot level, right foot, sequela

S96.112A Strain of muscle and tendon of long extensor muscle of toe at ankle and foot level, left foot, initial encounter

S96.112D Strain of muscle and tendon of long extensor muscle of toe at ankle and foot level, left foot, subsequent encounter

S96.112S Strain of muscle and tendon of long extensor muscle of toe at ankle and foot level,

Created on 09/28/2019. Page 30 of 33 ICD-10 CODE DESCRIPTION

left foot, sequela

S96.211A Strain of intrinsic muscle and tendon at ankle and foot level, right foot, initial encounter

S96.211D Strain of intrinsic muscle and tendon at ankle and foot level, right foot, subsequent encounter

S96.211S Strain of intrinsic muscle and tendon at ankle and foot level, right foot, sequela

S96.212A Strain of intrinsic muscle and tendon at ankle and foot level, left foot, initial encounter

S96.212D Strain of intrinsic muscle and tendon at ankle and foot level, left foot, subsequent encounter

S96.212S Strain of intrinsic muscle and tendon at ankle and foot level, left foot, sequela

S96.221A Laceration of intrinsic muscle and tendon at ankle and foot level, right foot, initial encounter

S96.221D Laceration of intrinsic muscle and tendon at ankle and foot level, right foot, subsequent encounter

S96.221S Laceration of intrinsic muscle and tendon at ankle and foot level, right foot, sequela

S96.811A Strain of other specified muscles and tendons at ankle and foot level, right foot, initial encounter

S96.811D Strain of other specified muscles and tendons at ankle and foot level, right foot, subsequent encounter

S96.811S Strain of other specified muscles and tendons at ankle and foot level, right foot, sequela

S96.812A Strain of other specified muscles and tendons at ankle and foot level, left foot, initial encounter

S96.812D Strain of other specified muscles and tendons at ankle and foot level, left foot, subsequent encounter

S96.812S Strain of other specified muscles and tendons at ankle and foot level, left foot, sequela

Group 1 Medical Necessity ICD-10 Codes Asterisk Explanation:

Group 1: Asterisk *Use G57.51, G57.52 or G57.53 for Tarsal Tunnel Syndrome with CPT 28899 (Unlisted procedure, foot or toes). *Use G57.61, G57.62 or G57.63 for Morton's metatarsalgia, neuralgia, or neuroma. NOTE: ONLY CPT 64455 or 64632 may be used with these diagnosis codes. *Use M72.0 for CPT codes 20527 and 26341.

ICD-10 Codes that DO NOT Support Medical Necessity

Created on 09/28/2019. Page 31 of 33 Group 1 Paragraph:

All ICD-10-CM codes not listed in this policy under ICD-10-CM Codes that Support Medical Necessity above.

Group 1 Codes:

N/A

Additional ICD-10 Information

N/A

Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type.Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

CODE DESCRIPTION

999x Not Applicable

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

CODE DESCRIPTION

99999 Not Applicable

Other Coding Information

N/A

Revision History Information

N/A

Associated Documents