ICD-10 Coding for Rotator Cuff Tendinitis(M75.31, M75.32)
Complete ICD-10-CM coding and documentation guide for Rotator Cuff Tendinitis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Rotator Cuff Tendinitis
M75.3-M75.4Primary Range
Tendinitis of the shoulder region
This range includes specific codes for tendinitis of the rotator cuff, detailing the specific tendons involved.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M75.31 | Tendinitis of supraspinatus | Use when supraspinatus tendon is specifically involved and confirmed by imaging. |
|
| M75.32 | Tendinitis of infraspinatus | Use when infraspinatus tendon is specifically involved and confirmed by imaging. |
|
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 rotator cuff tendinitis
Essential facts and insights about Rotator Cuff Tendinitis
Primary ICD-10-CM Codes for rotator cuff tendinitis
Decision Criteria
clinical Criteria
- Presence of supraspinatus tendon inflammation on imaging
documentation Criteria
- Detailed documentation of specific tendon involvement
Applicable To
- Supraspinatus tendinitis
Excludes
- Rotator cuff tear (M75.1-)
Clinical Validation Requirements
- MRI or ultrasound showing supraspinatus tendon inflammation without tear
- Positive Hawkins-Kennedy test
Code-Specific Risks
- Misclassification as rotator cuff tear
Coding Notes
- Ensure imaging confirms tendinitis without tear.
M75.32 - Tendinitis of infraspinatus
Use when infraspinatus tendon is specifically involved and confirmed by imaging.
Applicable To
- Infraspinatus tendinitis
Excludes
- Rotator cuff tear (M75.1-)
Clinical Validation Requirements
- MRI or ultrasound showing infraspinatus tendon inflammation without tear
- Positive external rotation resistance test
Coding Notes
Ensure imaging confirms tendinitis without tear.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Bursitis of shoulder
M75.5Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Rotator cuff tear
M75.1Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Rotator Cuff Tendinitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M75.31.
Impact
Clinical: Leads to inappropriate treatment plans., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials due to lack of specificity.
Mitigation Strategy
Use specific tendon names, Ensure imaging supports diagnosis
Impact
Reimbursement: Incorrect coding can lead to denied claims or incorrect DRG assignment., Compliance: Misclassification affects compliance with coding guidelines., Data Quality: Impacts accuracy of clinical data and patient records.
Mitigation Strategy
Use M75.3- codes when imaging confirms tendinitis without tear.
Impact
Risk of using unspecified codes when specific codes are available.
Mitigation Strategy
Ensure documentation includes specific tendon and imaging correlation.
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 Rotator Cuff Tendinitis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Rotator Cuff Tendinitis
Use these documentation templates to ensure complete and accurate documentation for Rotator Cuff Tendinitis. These templates include all required elements for proper coding and billing.
Chronic shoulder pain with confirmed tendinitis
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Specific tendon involvement
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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