ICD-10 Coding for Glenohumeral Joint Arthritis(M19.012, M19.211)
Complete ICD-10-CM coding and documentation guide for Glenohumeral Joint Arthritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Glenohumeral Joint Arthritis
M19.01-M19.93Primary Range
Primary and secondary osteoarthritis
This range includes codes for primary and secondary osteoarthritis, specifying laterality and type, which are essential for accurate coding of glenohumeral joint arthritis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M19.012 | Primary osteoarthritis, left shoulder | Use when primary osteoarthritis is confirmed in the left shoulder without any underlying trauma or surgery. |
|
| M19.211 | Post-traumatic osteoarthritis, right shoulder | Use when osteoarthritis is secondary to a previous injury or surgery in the right shoulder. |
|
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 glenohumeral joint arthritis
Essential facts and insights about Glenohumeral Joint Arthritis
Primary ICD-10-CM Codes for glenohumeral joint arthritis
Decision Criteria
clinical Criteria
- Radiographic evidence of osteoarthritis without history of trauma
documentation Criteria
- Documented as primary osteoarthritis with laterality specified
Applicable To
- Degenerative joint disease of the left shoulder
Excludes
- Post-traumatic osteoarthritis (M19.21-)
Clinical Validation Requirements
- Radiographic evidence of joint space narrowing
- Osteophyte formation
Code-Specific Risks
- Incorrectly coding as secondary osteoarthritis without evidence
Coding Notes
- Ensure laterality and type of osteoarthritis are documented to avoid unspecified coding.
M19.211 - Post-traumatic osteoarthritis, right shoulder
Use when osteoarthritis is secondary to a previous injury or surgery in the right shoulder.
Applicable To
- Degenerative joint disease due to previous injury
Excludes
- Primary osteoarthritis (M19.01-)
Clinical Validation Requirements
- History of shoulder trauma or surgery
- Radiographic changes consistent with osteoarthritis
Coding Notes
Ensure documentation of trauma or surgical history to support secondary osteoarthritis coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Glenohumeral Joint Arthritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M19.012.
Impact
Clinical: May lead to inappropriate treatment plans, Regulatory: Increases risk of non-compliance with coding standards, Financial: Potential for denied claims due to unspecified coding
Mitigation Strategy
Use structured templates for documentation, Regular training on documentation standards
Impact
Reimbursement: May lead to reduced reimbursement due to lack of specificity, Compliance: Increases risk of audit failures, Data Quality: Decreases accuracy of clinical data
Mitigation Strategy
Document laterality and type of osteoarthritis to use specific codes like M19.012 or M19.211.
Impact
Using unspecified codes can trigger audits due to lack of specificity.
Mitigation Strategy
Ensure all clinical documentation specifies laterality and type of osteoarthritis.
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 Glenohumeral Joint Arthritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Glenohumeral Joint Arthritis
Use these documentation templates to ensure complete and accurate documentation for Glenohumeral Joint Arthritis. These templates include all required elements for proper coding and billing.
Orthopedic evaluation for shoulder pain
Specialty: OrthopedicsRequired Elements
- Patient history including trauma
- Physical examination findings
- Radiographic evidence
- Diagnosis and treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Glenohumeral Joint Arthritis? Ask your questions below.