March 31, 2016

Question:
If a patient presented with symptoms of a meniscal tear in the right knee, but the type and location were not known without an MRI, would it be correct to report an “unspecified” code for right meniscal tear?

Answer:
Yes, it is correct to report the unspecified code (S83.206A Unspecified tear of unspecified meniscus, current injury, right knee, initial encounter). The ICD-10-CM guidelines state, “… unspecified codes should be reported when they are the codes that most accurately reflects what is known about the patient’s condition at the time of that particular encounter. It would be inappropriate to select a specific code that is not supported by the medical record documentation…”.

*This response is based on the best information available as of 03/31/16.