ICD-10 Coding for Labral Tear(S43.431A, M75.6)
Complete ICD-10-CM coding and documentation guide for Labral Tear. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Labral Tear
S43.43Primary Range
Superior glenoid labrum lesion
This range covers traumatic labral tears of the shoulder, including SLAP lesions.
Degenerative labral tear of shoulder
This range is used for degenerative labral tears associated with chronic conditions like osteoarthritis.
Labral tear of hip
This range includes labral tears of the hip, often associated with femoroacetabular impingement.
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 acute traumatic labral tears of the right shoulder during the initial encounter. |
|
| M75.6 | Degenerative labral tear of shoulder | Use when the labral tear is due to degenerative changes and associated with osteoarthritis. |
|
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 labral tear
Essential facts and insights about Labral Tear
Primary ICD-10-CM Codes for labral tear
Decision Criteria
clinical Criteria
- Presence of acute trauma and positive imaging findings
Applicable To
- Traumatic SLAP tear
Excludes
- Degenerative labral tear (M75.6)
Clinical Validation Requirements
- MRI or arthroscopy confirmation
- Detailed mechanism of injury
Code-Specific Risks
- Incorrect laterality
- Misclassification of encounter type
Coding Notes
- Ensure documentation specifies the type and location of the tear.
M75.6 - Degenerative labral tear of shoulder
Use when the labral tear is due to degenerative changes and associated with osteoarthritis.
Applicable To
- Chronic labral tear with osteoarthritis
Excludes
- Traumatic labral tear (S43.43)
Clinical Validation Requirements
- Chronic pain history
- Imaging showing degenerative changes
Coding Notes
Ensure documentation links the tear to degenerative changes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Aftercare following joint surgery
Z47.81Differential 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 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 patient records, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Always include laterality in documentation, Use templates that prompt for side specification
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data and statistics.
Mitigation Strategy
Always specify the side and whether the encounter is initial, subsequent, or sequela.
Impact
Inadequate documentation of the type and location of SLAP tears can lead to audit issues.
Mitigation Strategy
Ensure detailed operative reports and imaging findings are included in the patient record.
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 Labral Tear, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Labral Tear
Use these documentation templates to ensure complete and accurate documentation for Labral Tear. These templates include all required elements for proper coding and billing.
Acute SLAP tear from fall
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Imaging findings
- Type and location of tear
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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