0545 Electrothermal Arthroscopy Medical Clinical Policy

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Electrothermal Arthroscopy

POLICY HISTORY

Last Review: 07/09/2021

Effective: 06/22/2001

Next Review: 05/26/2022

Review History

Definitions

Additional Information

Clinical Policy Bulletin

Notes

Number: 0545

POLICY

*Please see amendment for Pennsylvania Medicaid at the end of this CPB.

Aetna considers electrothermal arthroscopy (also known as

electrothermally-assisted capsule shift, and electrothermally-assisted

capsulorrhaphy (ETAC)) of the joint capsule, ligaments, or tendons

experimental and investigational for all indications, including any of the

following because available scientific evidence does not permit

conclusions concerning the long-term effects on health outcomes (not an

all-inclusive list):

Achilles injuries; or

Adhesive capsulitis; or

Ankle, hip, knee, or thumb instability; or

Bankart lesions; or

Bony avulsion of the capsule; or

Deficient or thin capsule; or

Frozen shoulder; or

Glenohumeral joint (shoulder) instability; or

Hill-Sachs lesions; or

Humeral-side avulsion of the capsule; or

Ligament tear and meniscal injury of the knee; or

Multi-directional instability; or

Partial scapholunate ligament tears; or

Temporomandibular joint dislocation; or


Wrist injuries.

See also CPB 0475 - Coblation (../400_499/0475.html).

BACKGROUND

Thermal capsular shrinkage, also known as thermal capsulorrhaphy, is an

arthroscopic procedure performed under general anesthesia that utilizes

thermal energy/heat to shrink the tendons or ligaments of the synovial

joint. Thermal capsulorrhaphy purportedly increases stability of the joint. It

is theorized that when heat is applied to the tissue a molecular change

occurs to the structure of collagen (the chief component of connective

tissue, tendons and bones) causing the length of the collagen to shrink

and tighten.

Examples of thermal capsular shrinkage devices include, but may not be

limited to: ArthroCare system 2000 CAPS X ArthroWand; ORA-50

electrothermal system and accessories; VULCAN EAS electrothermal

arthroscopy system and accessories; VAPR TC electrode for use with

VAPR II electrosurgical system.

The shoulder joint is a ball and socket type of joint that permits a wide

range of movement. Its bony structures include the humerus and the

shallow cavity (the glenoid) of the shoulder blade, thus making it

inherently unstable. A circle of ligaments, tendons, muscles and cartilage

form a capsule around the joint to maintain stability. The glenoid labrum

is the fibro-cartilage ring attached to the rim of the glenoid cavity, and acts

to stabilize the humeral head inside the glenoid. The Bankart lesion is a

specific injury to a part of the shoulder joint called the labrum.

Shoulder instability is defined as excessive movements of the shoulder

that cause pain in daily activities or sporting activities. Dislocations occur

when the head of the humerus completely pops out of the socket, and

typically are the result of a complete dislocation with capsulo-labral

avulsion, a tearing away of the labrum from the glenoid rim. The first few

times this happens, it is usually with significant, high-energy trauma.

After that, it can get easier and easier for the joint to dislocate. Most


shoulder dislocations are anterior. Subluxation is the feeling that the

shoulder slips slightly out of socket, then immediately comes back in

place.

The cause of this instability varies. Sometimes it is the result of an

abnormal, generalized hyperlaxity of the capsule usually caused by

repetitive microtrauma, such as in overhead throwing sports, racquet

sports, and swimming. It can also result from recurrent partial or full

anterior dislocations of the shoulder. Aching, heaviness, or sharp pains

associated with pathologic conditions of the rotator cuff, biceps, or labrum

are common presenting complaints.

The main goal for any shoulder surgery is to stabilize the shoulder and

maintain a full, pain-free range of motion. The multiplicity of procedures

that address this problem have in common either blocking anterior

displacement of the humerus and/or tightening the joint capsule. For

long-term shoulder health, anatomic stabilization of the Bankart lesion is

the first priority because it corrects uni-directional anterior

subluxation/dislocation. The Bankart procedure involves a small incision

(1 cm) into the shoulder, and a suturing of the labrum back to the glenoid.

The Bankart repair reduces pain and can be performed without causing a

significant loss of external rotation.

Anatomic re-attachment of the capsulo-labral complex alone may not

successfully stabilize the gleno-humeral joint. It has been proposed that

the higher recurrence rates seen in arthroscopic repairs that secure the

capsulo-labral complex back to the glenoid rim may be the result of failure

to treat the stretched-out capsule. Electrothermally-assisted

capsulorrhaphy (ETAC), also known as electrothermal arthroscopy and

electrothermally-assisted capsule shift, provides an easy approach to

arthroscopically advance or tighten the capsule in conjunction with

arthroscopic re-attachment procedures.

The ElectroThermal Arthroscopy System uses high-energy

radiofrequency waves to heat the collagen fibers in the joint. This

controlled thermal energy eventually causes contraction and firming up of

the soft tissue in an effort to stabilize the joint. Initial success of this

procedure appears to depend on proper patient selection, appropriate

surgical technique, attention to the rehabilitation program, and patient


compliance. Monopolar electrothermal stabilization is technically easy to

perform, and reported peri-operative complication rates have been low.

Short-term, uncontrolled studies of electrothermal arthroscopy for

shoulder instability have shown preservation of range of motion and more

rapid post-operative recovery than with open procedures. Although

results of short-term studies of electrothermal arthroscopy appear to

equal or exceed other surgical procedures, longer-term clinical outcome

studies with direct comparisons with open procedures are necessary to

determine the effectiveness of electrothermal arthroscopy. Long-term

follow-up is necessary to determine whether results for this procedure will

deteriorate over time.

In this regard, a number of investigators have commented on the need for

long-term follow-up studies of electrothermal arthroscopy for shoulder

instability. Levine et al (2001) reported that the advances in thermal

treatment of the capsule have made arthroscopic electrothermal

capsulorrhaphy increasingly attractive as an alternative to the open

approach for the primary treatment of multi-directional instability.

However, the authors concluded that longer follow-ups will be necessary

before definitive statements can be made regarding the arthroscopic

techniques. Khan et al (2002) noted that monopolar electrothermal

stabilization of the shoulder shows considerable promise as a treatment

alternative in athletes and patients with recurrent instability. However,

long-term follow-up is necessary to determine if results for this procedure

deteriorate over time, especially in patients with m ulti-directional

instability. Furthermore, Walton et al (2002) noted that “[g]ood results

have been reported with this technique in recent short-term studies” but

that “[f]urther long-term evaluations are necessary to evaluate the

technique, indications, and results of this novel method of reducing

capsular volume”. Levitz et al (2001) cautioned that it is not known how

much the capsule should be shrunk or what long-term results will show.

Current evidence supporting the use of electrothermal arthroscopy for

shoulder instability is limited to uncontrolled retrospective (Hovis et al,

2002; Lephart et al, 2002; Levitz et al, 2001; Lyons et al, 2001; Reinold et

al, 2003; Joseph et al, 2003) and prospective case series, with variable

results (Fitzgerald et al, 2002; Levy et al, 2000; Mishra et al, 2001; Savoie

et al, 2000; Noonan et al, 2003; and Gieringer, 2003). Most of these

studies are small and of short duration, although some mid-term results


have been reported. There is a lack of adequate well-controlled long

term clinical studies of the effectiveness and durability of electrothermal

arthroscopy, comparing outcomes of this procedure with established

surgical methods of treating shoulder instability.

In a review of the literature on electrothermal arthroscopy, Gerber and

Warner (2002) of the Harvard Shoulder Service have warned that

“Currently, however, the indications for thermal capsulorrhaphy are

defined poorly, clinical outcome has not been shown to be superior to

conventional stabilization procedures, and long-term effects on joint

biology and mechanics are not known. Based on a critical review of the

literature and personal clinical experience, the authors conclude that

additional experimental and clinical investigations are necessary to add

this procedure to the accepted modalities applied for the treatment of

shoulder instability”.

A technology assessment of electrothermal arthroscopy prepared for the

Washington State Department of Labor and Industries (2003) concluded

that, “[w]hile researchers have published their findings in peer-reviewed

journals, the evidence comes primarily from case series studies with

small study populations. Therefore, findings do not substantially show

thermal shrinkage’s efficacy or effectiveness for the treatment of shoulder

instability...”.

Recent studies by Enad et al (2004) as well as D'Alessandro et al (2004)

indicated that the long-term outcome of electrothermal arthroscopy is

unsatisfactory. Enad et al (2004) examined the effectiveness of

arthroscopic electrothermal capsulorrhaphy for the treatment of instability

in overhand athletes. Electrothermal capsulorrhaphy without labral repair

was used to treat 20 symptomatic overhand athletes (15 baseball, 3

softball, and 2 volleyball). A total of 19 patients were evaluated at a mean

of 23 months. Overall Rowe results were 10 excellent, 4 good, 2 fair, and

3 poor, with a mean score of 82. The overall mean American Shoulder

and Elbow Surgeons (ASES) score was 85.7 (mean pain score, 42.2;

mean score for activities of daily living, 43.5). Two failures (10 %)

required open shoulder stabilization. Ten athletes returned to their prior

level of sport, 3 returned to a lower level, and 6 were unable to return to

their sport. These preliminary results indicate that treatment of the

overhand athlete with isolated electrothermal capsulorrhaphy is favorable


but does not reproduce the success of open surgery. Overall recurrence

and failure rates were high. Instability in overhand athletes may require

something other than isolated electrothermal capsulorrhaphy to address

laxity.

D'Alessandro et al (2004) reported a “high rate of unsatisfactory results”

in a published prospective evaluations of the effectiveness of arthroscopic

electrothermal capsulorrhaphy with 2 to 5 years follow-up. This non-

randomized prospective study evaluated the indications and results of

thermal capsulorrhaphy in 84 subjects with shoulder instability. Subjects

underwent arthroscopic thermal capsulorrhaphy after initial assessment,

radiographs, and failure of a minimum of 3 months of non-operative

rehabilitation. Outcome measures included pain, recurrent instability,

return to work/sports, and the ASES Shoulder Assessment score. After a

median duration of follow-up of 38 months, overall results were excellent

in 33 participants (39 %), satisfactory in 20 (24 %), and unsatisfactory in

31 (37 %). The authors concluded that ”[t]he high rate of unsatisfactory

overall results (37 %), documented with longer follow-up, is of great

concern”. The authors cautioned that “[t]he enthusiasm for thermal

capsulorrhaphy should be tempered until further studies document its

efficacy”.

There is also a lack of evidence of the effectiveness of electrothermal

arthroscopy for other joints, including knee, ankle and elbow. The most

thoroughly studied indication for electrothermal arthroscopy, other than

shoulder instability, is anterior cruciate ligament (ACL) laxity. Carter et al

(2002) reported failure at an average of 4 months post-surgery in 11 of 18

patients with laxity of the ACL treated with electrothermal arthroscopy. Of

the 7 patients with a good result, 6 were treated for acute laxity. The

investigators concluded “[e]ven with the short-term follow-up in our study,

it is evident that thermal shrinkage using radiofrequency technologyhas

limited application for patients with anterior cruciate ligament laxity.

Although it may be useful in treating patients with an acutely injured

native anterior cruciate ligament, further study is needed to see if the

ligament stretches out over time or is at increased risk of reinjury.” Indelli

and co-workers (2003) reported their experience using monopolar thermal

repair on 28 consecutive knees with partial ACL tears. Based on

measurements of ACL stability 2 or more years after surgery, the authors

found the results to be comparable to experience with ACL re


constructions with allograft. The authors stated, however, that longer

follow-up and the results of other studies will better define the selection,

methods, and results of thermal repair of partial ACL tears. Oakes and

McAllister (2003) stated that although the use of thermal energy to

selectively shrink tissues may ultimately prove to be an invaluable tool,

the lack of well-designed, randomized controlled studies to firmly

establish its efficacy in the treatment of partial cruciate injuries mandates

cautious use of this technique at this time. A technology assessment

prepared for the Washington State Department of Labor and Industries

(2003) concluded that there is inadequate evidence of the effectiveness

of electrothermal arthroscopy for ACL laxity.

In a review on thermal modification of the lax ACL by means of

radiofrequency, Lubowitz (2005) stated that results of shrinkage of a lax,

intact native ACL using radiofrequency seems promising, but

complications of catastrophic, spontaneous ACL rupture have been

reported. The author noted that more research is needed to define

treatment techniques, indications, and selection criteria for ACL thermal

shrinkage using radiofrequency and to compare its outcomes with

traditional ACL reconstructive surgery.

In a a multi-center study, Smith and colleagues (2008) prospectively

evaluated the mid-term results (beyond 2 years) of thermal shrinkage on

both lax native ACL and lax re-constructions and determined the

effectiveness of this procedure. A total of 64 patients underwent

electrothermal shrinkage for a lax ACL, both native and previous re

constructions. They were followed-up past 2 years with KT-1000

measurements. Failure criteria were subsequent operations for instability

and KT-1000 measurements greater than 5 mm. Three patients were lost

to follow-up. Among the 61 patients followed-up past 2 years, failure

occurred in 31 (50.8 %). The failure rate for lax grafts alone was 78.9 %,

and there was a failure rate of 38.1 % for lax native ligaments. The

authors concluded that electrothermal shrinkage of lax native or re

constructed ACLs is not an appropriate treatment.

Chloros et al (2008) reviewed the recent literature on arthroscopic

treatment of distal radius fractures (DRFs), triangular fibro-cartilage

complex injuries, inter-carpal ligament injuries, and ganglion cysts,

including the use of electrothermal devices. A major advantage of


arthroscopy in the treatment of DRFs is the accurate assessment of the

status of the articular surfaces and the detection of concomitant injuries.

Non-randomized studies of arthroscopically assisted reduction of DRFs

show satisfactory results, but there is only 1 prospective randomized

study showing the benefits of arthroscopy compared with open reduction-

internal fixation. Wrist arthroscopy plays an important role as part of the

treatment for DRFs; however, the treatment for each practitioner and

each patient needs to be individualized. Wrist arthroscopy is the gold

standard in the diagnosis and treatment of triangular fibro-cartilage

complex injuries. Type 1A injuries may be successfully treated with

debridement, whereas the repair of type 1B, 1C, and 1D injuries gives

satisfactory results. For type 2injuries, the arthroscopic wafer procedure

is equally effective as ulnar shortening osteotomy but is associated with

fewer complications in the ulnar positive wrist. With interosseous

ligament injuries, arthroscopic visualization provides critical diagnostic

value. Debridement and pinning in the acute setting of complete ligament

tears are promising and proven. In the chronic patient, arthroscopy can

guide re-constructive options based on cartilage integrity. The preliminary

results of wrist arthroscopy using electrothermal devices are encouraging;

however, complications have been reported, and therefore, their use is

controversial. In dorsal wrist ganglia, arthroscopy has shown excellent

results, a lower rate of recurrence, and no incidence of scapholunate

interosseous ligament instability compared with open ganglionectomy.

Arthroscopy in the treatment of volar wrist ganglia has yielded

encouraging preliminary results; however, further studies are warranted to

evaluate the safety and effectiveness of arthroscopy.

Chu and colleagues (2009) examined if radiofrequency electrothermal

treatment of thumb basal joint instability could produce clinical

improvement and result in successful functional outcomes for patients.

From August 2001 to April 2006, these researchers treated 17 thumbs

with symptomatic thumb basal joint instability using arthroscopic

electrothermal shrinkage of the volar ligaments and joint capsule with a

monopolar radiofrequency probe. The sample included 11 men and 6

women with a mean age of 35.3 years (range of 20 to 60 years). All

patients underwent regular clinical follow-up at a mean of 41 months

(range of 24 to 80 months). Pain improved in all thumbs after surgery.

Thumb pinch strength significantly improved in all thumbs after surgery (p

< 0.01). All patients were satisfied with the results and returned to their


pre-injury activities. The authors concluded that by use of the described

method of arthroscopic electrothermal shrinkage of the volar ligaments

and joint capsule in patients with symptomatic thumb basal joint

instability, most patients had good subjective results and the pinch

strength improved significantly in most patients. Of 17 thumbs, 16 had

satisfactory subjective and functional stability at a minimum 2 years'

follow-up. This was a small, non-controlled study; its findings need to be

validated by well-designed studies.

Torres and McCain (2012) noted that acute temporomandibular joint

dislocation is a common occurrence that is generally treated by

conservative therapy. In some patients, this can become a chronic

recurrent condition. This recurrent temporomandibular jointdislocation

(RTD) can significantly decrease the patient's quality of life and require

some form of surgical intervention for correction. These researchers

examined the effectiveness of a minimally invasive alternative treatment

for RTD using operative arthroscopy. A total of 11 patients treated for

RTD between 2004 and 2010 were retrospectively analyzed.

Electrothermal capsulorrhaphy was performed using a standard double

puncture operative arthroscopy with a Hol:YAG laser and/or

electrocautery. Post-operatively, the patients were monitored for 6

months to 6 years. Of the 11 subjects, 2 suffered a recurrence of

temporomandibular dislocation and required open arthrotomy for

correction. The other 9 patients had no signs of recurrence or any

significant post-operative loss of function. The authors concluded that

electrothermal capsulorrhaphy is an effective and minimally invasive

method for the treatment of RTD. The findings of this small, non-

controlled study need to be validated by well-designed studies.

The triangular fibro-cartilage complex (TFCC) is formed by the triangular

fibro-cartilage discus, the radio-ulnar ligaments and the ulno-carpal

ligaments. Garcia-Lopez et al (2012) evaluated the clinical and

occupational outcomes of arthroscopic treatment with electrothermal

shrinkage for TFCC tears. These researches retrospectively reviewed

162 patients. All patients had ulnar-sided wrist pain that limited their

occupational and sporting activities. The surgical technique consisted of

electrothermal collagen shrinkage of the TFCC. Pain relief, range of

motion, complications, re-operation rate, time to return to work and

workers' compensation claims were evaluated. Exclusion criteria were


distal radioulnar joint instability and association of other wrist lesions.

Complete pain relief was noted in 80.3 % of the patients, incomplete pain

relief in 14.8 %, and only 4.9 % required re-operation because of pain-

persistence. The average range of motion was over 90 % compared to

the opposite hand. Worker's compensation claims were introduced by 20

patients, of which 6 did not return to their previous occupation. The

authors concluded that electrodiathermy may be a useful option for

arthroscopic treatment of TFCC tears in cases without distal radioulnar

joint instability. The findings of this study need to be validated by well-

designed studies.

Mohtadi et al (2014) noted that radiofrequency technology for shoulder

instability was rapidly adopted despite limited clinical evidence and a poor

understanding of its indications. Reports of serious adverse events

followed, leading to its abandonment. These researchers presented

findings from a multi-center randomized clinical trial evaluating the safety

and effectiveness of ETAC compared with open inferior capsular shift

(ICS) and reviewed the role of randomized trials in adopting new

technology. Patients (greater than 14 years) diagnosed with multi-

directional instability or multi-directional laxity with antero-inferior

instability and failed non-operative treatment were enrolled. Patients with

bone lesions or labral, biceps anchor, or full-thickness rotator cuff tears

were excluded intra-operatively. Outcomes included Western Ontario

Shoulder Instability Index, function and recurrent instability at 2 years

post-operatively, and surgical times. A total of 54 subjects (mean age of

23 years; 37 women) were randomized to ETAC (n = 28) or open ICS (n =

26). The groups were comparable at baseline, except for external

rotation at the side. At 2 years post-operatively, there were no statistically

or clinically significant differences between groups for the Western

Ontario Shoulder Instability Index (p = 0.71), American Shoulder and

Elbow Surgeons score (p = 0.43), Constant score (p = 0.43), and active

range of motion. Recurrent instability was not statistically different

(ETAC, 2; open, 4; p = 0.41). Electrothermally-assisted capsulorrhaphy

(23 minutes) was significantly shorter than open ICS (59 minutes) (p <

0.01) surgery. Three subjects (1 ETAC, 2 open) had stiff shoulders. The

authors concluded that at 2 years post-operatively, quality of life and

functional outcomes between groups were not clinically different; ETAC


had fewer complications and episodes of recurrence compared with open

surgery. They stated that this evidence reinforced the need to critically

evaluate new technology before widespread clinicaluse.

UpToDate reviews on “Overview of surgical therapy of knee and hip

osteoarthritis” (Mandl and Marin, 2015), “Synovectomy for inflammatory

arthritis of the knee” (Wright, 2015) do not mention electrothermal

arthroscopy/ETAC as a therapeutic option.

McRae and associates (2016) noted that ETAC was introduced as an

adjunct to shoulder stabilization surgery to address capsular laxity in the

treatment of traumatic anterior dislocation. No previous randomized

controlled trial (RCT) has compared arthroscopic Bankart repair with

ETAC of the medial gleno-humeral ligament and anterior band of the

inferior gleno-humeral ligament versus undergoing arthroscopic Bankart

repair alone. These investigators hypothesized that there would be no

difference in quality of life (QOL) between these 2 groups.

Complication/failure rates were also compared. A total of 88 patients

were randomly assigned to receive arthroscopic Bankart repair with (n =

44) or without ETAC (n = 44). Post-operative visits occurred at 3, 6, 12,

and 24 months with WOSI, ASES, and Constant scores completed, and

rates of dislocation/subluxation were determined. Data on 74 patients

were analyzed, with the rest lost to follow-up. There were no differences

between groups at any post-surgery time points for WOSI, ASES, or

Constant scores (non-significant.); 8 patients in the no-ETAC group and 7

in the ETAC group were considered failures (non-significant). The

authors concluded that no benefits in patient-reported outcome or

recurrence rates using ETAC were found. Mean WOSI scores 2 years

post-surgery were virtually identical for the 2 groups; ETAC could not be

shown to provide benefit or detriment when combined with arthroscopic

labral repair for traumatic anterior instability of the shoulder.

UpToDate reviews on “Anterior cruciate ligament injury” (Friedberg, 2017)

and “Meniscal injury of the knee” (Cardone and Jacobs, 2017) do not

mention electrothermal arthroscopy as a therapeuticoption.

Partial Scapholunate Ligament Tears

In a prospective study, Crespo Romero and colleagues (2020) examined

the outcomes of arthroscopic electrothermal shrinkage for partial

scapholunate (SL) ligament tears, isolated or with associated triangular

fibrocartilage complex (TFCC) injuries. This trial included 20 patients with

symptomatic instability of SL ligament (14 of them also with TFCC wrist

injuries) treated with arthroscopic electrothermal shrinkage using a

monopolar radiofrequency probe. No patient showed radiologic signs of

static dissociation (mean SL interval =of 2.2 ± 0.6 mm; mean SL angle of

41.4° ± 6.7°) before surgery. All participants underwent follow-up at the

authors’ clinic regularly for an average of 50.6 months (range of 29 to 80

months). The modified Mayo wrist score improved from a mean of 59 ±

17.1 points pre-operatively to 88.3 ± 16.2 points at the final follow-up. At

the final clinical examination, a painful Watson scaphoid shift test was

found in 3 patients (15 %). The mean flexion-extension arc was

unchanged (132° ± 19°), and mean grip strength improved 12 kg. No

patient showed radiologic signs of arthritis or instability after surgery

(mean SL interval of 1.9 ± 0.7 mm; mean SL angle of 42.7° ± 7.3°). Of

the 14 patients with combined TFCC injuries, 3 patients continued

complaining of ulnar-sided point tenderness. At the end of the follow-up,

80 % of the subjects were satisfied or very satisfied. The authors

concluded that SL ligament and TFCC electrothermal shrinkage

effectively provided pain relief and grip strength increase for most of the

patients treated. Level of Evidence = IV. This was a small (n = 20) study

that provided Level IV evidence; these findings need to be validated by

well-designed studies.


Code Code Description

29804 Arthroscopy, temporomandibular joint, surgical



29806 -

29828

Arthroscopy, shoulder, surgical

29843 -

29847

Arthroscopy, wrist, surgical

29848 Endoscopy, wrist surgical, with release of transverse

carpal ligament

29861 -

29863

Arthroscopy, hip, surgical

29870 -

29887

Arthroscopy, knee [not covered for electrothermal

arthroscopy]

29891 -

29899

Arthroscopy, ankle

29905 Arthroscopy, subtalar joint, surgical; with synovectomy

29906 with debridement

29907 with subtalar arthrodesis

S2300 Arthroscopy, shoulder, surgical; with thermally-induced

capsulorrhaphy

M23.000 -

M23.92

Internal derangement of knee

M24.00 -

M25.9

Other specific joint derangements

M26.601 -

M26.69

Temporomandibular joint disorders

M65.871 -

M65.879

Other synovitis and tenosynovitis of ankle and foot



M75.00 -

M75.02

Adhesive capsulitis of shoulder

M76.60 -

M76.62

Achilles tendinitis

Numerous

options

Sprains and strains of wrist [Codes not listed due to

expanded specificity]

Numerous

options

Sprains and strains of ankle and foot [Codes not listed

due to expanded specificity]

Numerous

options

Injury, elbow, forearm, and wrist [Codes not listed due to

expanded specificity]

S03.00x+ -

S03.02x+

Dislocation of jaw

S63.511A -

S63.519S

Sprain of carpal (joint) of wrist [partial scapholunate

ligament tears]

S76.111A -

S76.119S

Strain of quadriceps muscle, fascia and tendon

S83.200A -

S83.32xS

Tear of meniscus, current injury

S83.401A -

S83.429S

Sprain of collateral ligament of knee

S83.501A -

S83.529S

Sprain of cruciate ligament of knee

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