ICD-10 Coding for Shoulder Dislocation(S43.004A)
Complete ICD-10-CM coding and documentation guide for Shoulder Dislocation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Shoulder Dislocation
S43.0Primary Range
Dislocation of shoulder joint
This range includes all types of shoulder dislocations, specifying laterality and encounter type.
Key Information: ICD-10 code for left shoulder dislocation
Essential facts and insights about Shoulder Dislocation
Primary ICD-10-CM Code for shoulder dislocation
Decision Criteria
clinical Criteria
- Confirmed anterior dislocation via imaging
documentation Criteria
- Documentation includes laterality and encounter type
Applicable To
- Anterior dislocation of right shoulder
Excludes
- Fracture of shoulder
Clinical Validation Requirements
- X-ray confirmation of anterior dislocation
- Clinical examination showing anterior displacement
Code-Specific Risks
- Incorrect laterality documentation
- Missing encounter type
Coding Notes
- Ensure documentation specifies laterality and encounter type to avoid unspecified codes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Pain in right shoulder
M25.511Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Anterior dislocation of left shoulder joint, initial encounter
S43.005ADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Shoulder Dislocation to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S43.004A.
Impact
Clinical: May lead to incorrect treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials or reduced payments.
Mitigation Strategy
Always include encounter type in documentation., Use templates to ensure completeness.
Impact
Reimbursement: May lead to reduced reimbursement rates., Compliance: Increases risk of audit and non-compliance., Data Quality: Decreases accuracy of health records.
Mitigation Strategy
Ensure documentation specifies right or left shoulder.
Impact
Using unspecified codes increases audit risk.
Mitigation Strategy
Ensure documentation specifies laterality and encounter type.
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 Dislocation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Shoulder Dislocation
Use these documentation templates to ensure complete and accurate documentation for Shoulder Dislocation. These templates include all required elements for proper coding and billing.
Initial encounter for anterior shoulder dislocation
Specialty: OrthopedicsRequired Elements
- Patient demographics
- Mechanism of injury
- Imaging results
- Reduction technique
- Post-reduction status
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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