ICD-10 Coding for Acromioclavicular Joint Arthritis(M19.011, M19.012, M19.211)
Complete ICD-10-CM coding and documentation guide for Acromioclavicular Joint Arthritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Acromioclavicular Joint Arthritis
M19.01-M19.93Primary Range
Osteoarthritis of shoulder
This range includes codes for primary and secondary osteoarthritis of the shoulder, including the acromioclavicular joint.
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 primary osteoarthritis is diagnosed in the right AC joint with imaging confirmation. |
|
| M19.012 | Primary osteoarthritis, left shoulder | Use when primary osteoarthritis is diagnosed in the left AC joint with imaging confirmation. |
|
| M19.211 | Secondary osteoarthritis, right shoulder | Use for secondary osteoarthritis in the right AC joint due to previous trauma. |
|
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 AC joint arthritis
Essential facts and insights about Acromioclavicular Joint Arthritis
Primary ICD-10-CM Codes for before meals joint arthritis
Decision Criteria
clinical Criteria
- Confirmed by imaging showing osteophytes and joint space narrowing
documentation Criteria
- Documentation must specify 'primary osteoarthritis' and laterality
Applicable To
- Primary osteoarthritis of the right AC joint
Excludes
- Rheumatoid arthritis (M05.4-)
Clinical Validation Requirements
- X-ray showing osteophytes and joint space narrowing
- Clinical documentation of chronic shoulder pain
Code-Specific Risks
- Misclassification as unspecified osteoarthritis
- Failure to document laterality
Coding Notes
- Ensure laterality is documented and confirmed by imaging.
M19.012 - Primary osteoarthritis, left shoulder
Use when primary osteoarthritis is diagnosed in the left AC joint with imaging confirmation.
Applicable To
- Primary osteoarthritis of the left AC joint
Excludes
- Rheumatoid arthritis (M05.4-)
Clinical Validation Requirements
- X-ray showing osteophytes and joint space narrowing
- Clinical documentation of chronic shoulder pain
Coding Notes
Ensure laterality is documented and confirmed by imaging.
M19.211 - Secondary osteoarthritis, right shoulder
Use for secondary osteoarthritis in the right AC joint due to previous trauma.
Applicable To
- Post-traumatic osteoarthritis of the right AC joint
Excludes
- Rheumatoid arthritis (M05.4-)
Clinical Validation Requirements
- History of trauma or previous injury
- Imaging showing degenerative changes
Coding Notes
Document the causative trauma and sequence appropriately.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Pain in right shoulder
M25.511Pain in left shoulder
M25.512Sprain of acromioclavicular joint, sequela
S43.5XXSDifferential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Rheumatoid arthritis with involvement of right shoulder
M05.411Rheumatoid arthritis with involvement of left shoulder
M05.412Primary osteoarthritis, right shoulder
M19.011Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Acromioclavicular Joint Arthritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M19.011.
Impact
Clinical: Inaccurate treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential for denied claims
Mitigation Strategy
Always include laterality in documentation, Use templates to ensure completeness
Impact
Reimbursement: May lead to lower reimbursement rates, Compliance: Non-compliance with coding guidelines, Data Quality: Decreased accuracy in health records
Mitigation Strategy
Ensure documentation specifies laterality and type of osteoarthritis
Impact
Using unspecified codes when specific ones are available
Mitigation Strategy
Ensure documentation supports specific code selection
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 Acromioclavicular Joint Arthritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Acromioclavicular Joint Arthritis
Use these documentation templates to ensure complete and accurate documentation for Acromioclavicular Joint Arthritis. These templates include all required elements for proper coding and billing.
Diagnosis of primary osteoarthritis in the AC joint
Specialty: OrthopedicsRequired Elements
- Patient history
- Imaging results
- Laterality
- Type of osteoarthritis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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