ICD-10 Coding for Arthritis of the Shoulder(M19.011, M19.012)
Complete ICD-10-CM coding and documentation guide for Arthritis of the Shoulder. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Arthritis of the Shoulder
M19.011-M19.019Primary Range
Primary osteoarthritis of the shoulder
These codes are used for primary osteoarthritis affecting the shoulder, specifying laterality.
Post-traumatic osteoarthritis of the shoulder
These codes are used when osteoarthritis develops following a trauma to the shoulder.
Traumatic arthropathy of the shoulder
These codes are used for arthropathy resulting from direct trauma to the shoulder.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M19.011 | Primary osteoarthritis, right shoulder | Use when imaging confirms primary OA in the right shoulder without trauma history. |
|
| M19.012 | Primary osteoarthritis, left shoulder | Use when imaging confirms primary OA in the left shoulder without trauma history. |
|
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 arthritis shoulder
Essential facts and insights about Arthritis of the Shoulder
Primary ICD-10-CM Codes for arthritis shoulder
Decision Criteria
clinical Criteria
- Confirmed by imaging and absence of trauma history
Applicable To
- Degenerative joint disease of the right shoulder
Excludes
- Post-traumatic osteoarthritis (M19.111)
Clinical Validation Requirements
- X-ray showing joint space narrowing
- Absence of rheumatoid factor
Code-Specific Risks
- Misclassification if trauma history is present
Coding Notes
- Ensure laterality is documented; use only if no trauma history.
M19.012 - Primary osteoarthritis, left shoulder
Use when imaging confirms primary OA in the left shoulder without trauma history.
Applicable To
- Degenerative joint disease of the left shoulder
Excludes
- Post-traumatic osteoarthritis (M19.112)
Clinical Validation Requirements
- X-ray showing joint space narrowing
- Absence of rheumatoid factor
Coding Notes
Ensure laterality is documented; use only if no trauma history.
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 Arthritis of the Shoulder to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M19.011.
Impact
Clinical: Leads to incorrect treatment plans., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always document the specific type of arthritis.
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Assign separate codes for each shoulder, e.g., M19.011 and M19.012.
Impact
Failure to document laterality can lead to coding errors.
Mitigation Strategy
Use templates that prompt 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 Arthritis of the Shoulder, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Arthritis of the Shoulder
Use these documentation templates to ensure complete and accurate documentation for Arthritis of the Shoulder. These templates include all required elements for proper coding and billing.
Primary osteoarthritis diagnosis
Specialty: OrthopedicsRequired Elements
- Patient history
- Imaging results
- Pain assessment
- Functional limitations
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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