ICD-10 Coding for Shoulder Conditions(M19.012, S43.014A)
Complete ICD-10-CM coding and documentation guide for Shoulder Conditions. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Shoulder Conditions
M19.01-M19.03Primary Range
Primary osteoarthritis of shoulder
Covers degenerative joint disease affecting the shoulder.
Rotator cuff syndrome and shoulder impingement
Includes conditions affecting the rotator cuff and shoulder impingement.
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 imaging confirms osteoarthritis in the left shoulder. |
|
| S43.014A | Anterior dislocation of right shoulder, initial encounter | Use for initial treatment of a traumatic anterior dislocation of 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 left shoulder pain
Essential facts and insights about Shoulder Conditions
Primary ICD-10-CM Codes for physician initials shoulder
Decision Criteria
clinical Criteria
- Confirmed by imaging studies
Applicable To
- Degenerative joint disease of left shoulder
Excludes
- Post-traumatic osteoarthritis
Clinical Validation Requirements
- Radiographic evidence of joint space narrowing
- Presence of osteophytes
Code-Specific Risks
- Misclassification if not confirmed by imaging
Coding Notes
- Ensure documentation specifies 'primary' osteoarthritis.
S43.014A - Anterior dislocation of right shoulder, initial encounter
Use for initial treatment of a traumatic anterior dislocation of the right shoulder.
Applicable To
- Traumatic dislocation of right shoulder
Excludes
- Chronic instability of shoulder
Clinical Validation Requirements
- Documented traumatic event leading to dislocation
Coding Notes
Ensure laterality and encounter type are documented.
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 Shoulder Conditions to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M19.012.
Impact
Clinical: Inaccurate treatment records, Regulatory: Non-compliance with coding guidelines, Financial: Potential claim denials
Mitigation Strategy
Include encounter type in documentation, Use 7th character for ICD-10 codes
Impact
Reimbursement: Claims may be denied or delayed., Compliance: Non-compliance with ICD-10 coding standards., Data Quality: Inaccurate patient records.
Mitigation Strategy
Always include laterality using RT/LT modifiers or specific ICD-10 characters.
Impact
Failure to document laterality can lead to audit findings.
Mitigation Strategy
Implement mandatory fields in EHR for laterality.
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 Shoulder Conditions, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Shoulder Conditions
Use these documentation templates to ensure complete and accurate documentation for Shoulder Conditions. These templates include all required elements for proper coding and billing.
Chronic shoulder pain evaluation
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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