ICD-10 Coding for Disorder of Rotator Cuff(M75.1, S46.01-)
Complete ICD-10-CM coding and documentation guide for Disorder of Rotator Cuff. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Disorder of Rotator Cuff
M75.1-M75.12Primary Range
Non-traumatic rotator cuff tear or rupture
This range covers degenerative tears of the rotator cuff, which are non-traumatic in nature.
Traumatic rotator cuff tear or rupture
This range is used for tears resulting from acute trauma, such as falls or sports injuries.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M75.1 | Rotator cuff tear or rupture, not specified as traumatic | Use when the tear is non-traumatic and degenerative. |
|
| S46.01- | Traumatic rupture of rotator cuff | Use when the tear is due to a specific traumatic event. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for non-traumatic rotator cuff tear
Essential facts and insights about Disorder of Rotator Cuff
Primary ICD-10-CM Codes for disorder of rotator cuff
Decision Criteria
clinical Criteria
- MRI shows degenerative changes without acute injury.
documentation Criteria
- Patient history lacks recent trauma.
Applicable To
- Degenerative rotator cuff tear
- Chronic rotator cuff tear
Excludes
- Traumatic rotator cuff tear (S46.01-)
Clinical Validation Requirements
- MRI or ultrasound confirming tear
- Documentation of chronicity or degenerative nature
Code-Specific Risks
- Misclassification as traumatic
- Lack of documentation on chronicity
Coding Notes
- Ensure documentation specifies non-traumatic nature.
S46.01- - Traumatic rupture of rotator cuff
Use when the tear is due to a specific traumatic event.
Applicable To
- Acute rotator cuff tear due to trauma
Excludes
- Degenerative rotator cuff tear (M75.1)
Clinical Validation Requirements
- Documented history of trauma
- Imaging confirming acute tear
Coding Notes
Ensure trauma is documented and linked to the tear.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Shoulder pain
M25.51-Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Disorder of Rotator Cuff to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M75.1.
Impact
Clinical: Misleading treatment plans, Regulatory: Potential audit issues, Financial: Incorrect billing
Mitigation Strategy
Always ask about recent injuries, Review imaging thoroughly
Impact
Reimbursement: May lead to incorrect payment rates., Compliance: Could result in audit discrepancies., Data Quality: Affects accuracy of patient records.
Mitigation Strategy
Verify patient history and imaging for signs of trauma.
Impact
Incorrectly coding a degenerative tear as traumatic.
Mitigation Strategy
Implement thorough documentation review processes.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Disorder of Rotator Cuff, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Disorder of Rotator Cuff
Use these documentation templates to ensure complete and accurate documentation for Disorder of Rotator Cuff. These templates include all required elements for proper coding and billing.
Orthopedic evaluation of shoulder pain
Specialty: OrthopedicsRequired Elements
- Patient history
- Imaging results
- Physical exam findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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