ICD-10 Coding for Adhesive Capsulitis(M75.0, M75.01, M75.02)
Complete ICD-10-CM coding and documentation guide for Adhesive Capsulitis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Adhesive Capsulitis
M75.0-M75.02Primary Range
Adhesive capsulitis of shoulder
This range covers the primary codes for adhesive capsulitis, including laterality.
Pain in shoulder
Used for documenting persistent shoulder pain associated with adhesive capsulitis.
Aftercare following joint surgery and other specified aftercare
Relevant for aftercare scenarios such as post-surgical or physical therapy after adhesive capsulitis treatment.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M75.0 | Adhesive capsulitis of shoulder | Use when adhesive capsulitis is diagnosed without specifying laterality. |
|
| M75.01 | Adhesive capsulitis of right shoulder | Use when adhesive capsulitis is diagnosed in the right shoulder. |
|
| M75.02 | Adhesive capsulitis of left shoulder | Use when adhesive capsulitis is diagnosed in the left 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 adhesive capsulitis
Essential facts and insights about Adhesive Capsulitis
Primary ICD-10-CM Codes for adhesive capsulitis
Decision Criteria
clinical Criteria
- Presence of shoulder stiffness and pain with restricted ROM.
documentation Criteria
- Laterality and stage of adhesive capsulitis documented.
Clinical Validation Requirements
- MRI showing capsular thickening >4mm
- Restricted ROM in shoulder
Code-Specific Risks
- Risk of unspecified laterality leading to denials.
Coding Notes
- Ensure laterality is documented to avoid using unspecified codes.
M75.01 - Adhesive capsulitis of right shoulder
Use when adhesive capsulitis is diagnosed in the right shoulder.
Applicable To
- Frozen shoulder, right
Excludes
- Rotator cuff tear (M75.1)
- Impingement syndrome (M75.4)
Clinical Validation Requirements
- MRI showing capsular thickening >4mm
- Restricted ROM in right shoulder
Coding Notes
Ensure documentation specifies right shoulder.
M75.02 - Adhesive capsulitis of left shoulder
Use when adhesive capsulitis is diagnosed in the left shoulder.
Applicable To
- Frozen shoulder, left
Excludes
- Rotator cuff tear (M75.1)
- Impingement syndrome (M75.4)
Clinical Validation Requirements
- MRI showing capsular thickening >4mm
- Restricted ROM in left shoulder
Coding Notes
Ensure documentation specifies left shoulder.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Adhesive Capsulitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M75.0.
Impact
Clinical: May lead to inappropriate treatment plans., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.
Mitigation Strategy
Educate providers on the importance of staging., Use templates that prompt for stage documentation.
Impact
Reimbursement: May lead to reduced reimbursement or denials., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Always document and code the specific laterality (M75.01 or M75.02).
Impact
Reimbursement: Incorrect sequencing may affect DRG assignment., Compliance: Violates coding rules for secondary conditions., Data Quality: Impacts the accuracy of patient records.
Mitigation Strategy
Ensure underlying condition is coded first, followed by M75.0.
Impact
Using unspecified codes when laterality is documented.
Mitigation Strategy
Implement checks to ensure laterality is documented and coded.
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 Adhesive Capsulitis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Adhesive Capsulitis
Use these documentation templates to ensure complete and accurate documentation for Adhesive Capsulitis. These templates include all required elements for proper coding and billing.
Orthopedic Evaluation for Adhesive Capsulitis
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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