ICD-10 Coding for Shoulder Labral Tear(S43.431A, S43.432A, S43.439A)
Complete ICD-10-CM coding and documentation guide for Shoulder Labral Tear. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Shoulder Labral Tear
S43.43-Primary Range
Superior glenoid labrum lesion
This range covers all types of shoulder labral tears, specifying laterality and encounter type.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S43.431A | Superior glenoid labrum lesion of right shoulder, initial encounter | Use for initial treatment of a right shoulder labral tear. |
|
| S43.432A | Superior glenoid labrum lesion of left shoulder, initial encounter | Use for initial treatment of a left shoulder labral tear. |
|
| S43.439A | Superior glenoid labrum lesion, unspecified shoulder, initial encounter | Use when laterality is not specified in the documentation. |
|
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 shoulder labral tear
Essential facts and insights about Shoulder Labral Tear
Primary ICD-10-CM Codes for shoulder labral tear
Decision Criteria
clinical Criteria
- MRI confirmation of SLAP lesion
documentation Criteria
- Documented laterality and encounter type
Applicable To
- SLAP lesion
- Bankart lesion
Excludes
- Rotator cuff tear (M75.1-)
Clinical Validation Requirements
- MRI showing SLAP lesion
- Positive O'Brien's test
Code-Specific Risks
- Incorrect laterality documentation
- Misclassification of encounter type
Coding Notes
- Ensure laterality and encounter type are clearly documented.
S43.432A - Superior glenoid labrum lesion of left shoulder, initial encounter
Use for initial treatment of a left shoulder labral tear.
Applicable To
- SLAP lesion
- Bankart lesion
Excludes
- Rotator cuff tear (M75.1-)
Clinical Validation Requirements
- MRI showing SLAP lesion
- Positive Speed's test
Coding Notes
Ensure laterality and encounter type are clearly documented.
S43.439A - Superior glenoid labrum lesion, unspecified shoulder, initial encounter
Use when laterality is not specified in the documentation.
Applicable To
- SLAP lesion
- Bankart lesion
Excludes
- Rotator cuff tear (M75.1-)
Clinical Validation Requirements
- MRI showing SLAP lesion
- Positive clinical tests
Coding Notes
Query for laterality if not documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Rotator cuff tear
M75.1-Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Rotator cuff tear or rupture
M75.1-Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Shoulder Labral Tear to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S43.431A.
Impact
Clinical: Ambiguity in treatment records., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Always document the affected side, Use templates that prompt for laterality
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use 29807 for repair and 29822 for debridement only.
Impact
Reimbursement: Claims may be denied or delayed., Compliance: Non-compliance with specificity requirements., Data Quality: Inaccurate patient records.
Mitigation Strategy
Verify laterality in documentation before coding.
Impact
Inadequate documentation of SLAP lesion type and repair method.
Mitigation Strategy
Use detailed templates and verify documentation completeness.
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 Labral Tear, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Shoulder Labral Tear
Use these documentation templates to ensure complete and accurate documentation for Shoulder Labral Tear. These templates include all required elements for proper coding and billing.
Arthroscopic SLAP repair
Specialty: Orthopedic SurgeryRequired Elements
- Indication for surgery
- Type of SLAP lesion
- Procedure details
- Post-operative plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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