ICD-10 Coding for Osteoarthritis of Left Shoulder(M19.012)
Complete ICD-10-CM coding and documentation guide for Osteoarthritis of Left Shoulder. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Osteoarthritis of Left Shoulder
M19.0-M19.9Primary Range
Other and unspecified osteoarthritis
This range includes codes for primary osteoarthritis affecting various joints, including the shoulder.
Key Information: ICD-10 code for osteoarthritis of left shoulder
Essential facts and insights about Osteoarthritis of Left Shoulder
Primary ICD-10-CM Code for osteoarthritis of left shoulder
Decision Criteria
clinical Criteria
- Presence of chronic degenerative changes in the left shoulder without trauma history.
documentation Criteria
- Documentation must include imaging findings and specify laterality.
Applicable To
- Degenerative joint disease of left shoulder
Excludes
- Post-traumatic osteoarthritis (M19.112)
Clinical Validation Requirements
- Radiographic evidence of joint space narrowing
- Presence of osteophytes
- Absence of systemic inflammatory markers
Code-Specific Risks
- Risk of using this code without confirming laterality
- Confusion with post-traumatic osteoarthritis
Coding Notes
- Ensure documentation specifies 'primary osteoarthritis' and 'left shoulder' to avoid unspecified coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Osteoarthritis of Left Shoulder 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 incorrect treatment plans., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims due to unspecified coding.
Mitigation Strategy
Always specify laterality in documentation., Use templates that prompt for specific details.
Impact
Reimbursement: Incorrect coding may lead to denied claims or incorrect DRG assignment., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data and statistics.
Mitigation Strategy
Use M19.112 if the osteoarthritis is post-traumatic.
Impact
Unspecified codes can lead to audit flags and reimbursement issues.
Mitigation Strategy
Ensure 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 Osteoarthritis of Left Shoulder, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Osteoarthritis of Left Shoulder
Use these documentation templates to ensure complete and accurate documentation for Osteoarthritis of Left Shoulder. These templates include all required elements for proper coding and billing.
Chronic left shoulder pain due to osteoarthritis
Specialty: OrthopedicsRequired Elements
- History of present illness
- Physical examination findings
- Imaging results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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