ICD-10 Coding for Labrum Tear(S43.431A)
Complete ICD-10-CM coding and documentation guide for Labrum Tear. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Labrum Tear
S43.43-Primary Range
Injury of the shoulder and upper arm
This range includes specific codes for labral tears, differentiating by encounter type and laterality.
Key Information: ICD-10 code for labrum tear
Essential facts and insights about Labrum Tear
Primary ICD-10-CM Code for labrum tear
Decision Criteria
clinical Criteria
- MRI confirmation of SLAP tear
documentation Criteria
- Detailed operative report specifying tear location and repair method
Applicable To
- SLAP tear
Excludes
- Rotator cuff tear (S46.011A)
Clinical Validation Requirements
- MRI or MRA confirmation of superior labrum tear
- Positive O'Brien's test
Code-Specific Risks
- Ensure MRI findings are documented to support the code.
Coding Notes
- Ensure laterality and encounter type are specified.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Recurrent dislocation, right shoulder
M24.411Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Bankart lesion of right shoulder, initial encounter
S43.421ADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Labrum 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 specify right or left shoulder in documentation.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Code 29806 for inferior labral repairs.
Impact
Bundling errors when coding multiple shoulder procedures.
Mitigation Strategy
Ensure distinct documentation for each procedure.
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 Labrum Tear, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Labrum Tear
Use these documentation templates to ensure complete and accurate documentation for Labrum Tear. These templates include all required elements for proper coding and billing.
SLAP Repair
Specialty: Orthopedic SurgeryRequired Elements
- Pre-op and post-op diagnosis
- Procedure details
- Tear location and repair method
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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