ICD-10 Coding for Left Shoulder Arthritis(M19.012, M19.112, M13.812)
Complete ICD-10-CM coding and documentation guide for Left Shoulder Arthritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Left Shoulder Arthritis
M19.01-M19.12Primary Range
Primary and post-traumatic osteoarthritis of shoulder
This range includes the primary codes for osteoarthritis affecting the left shoulder, both primary and post-traumatic.
Other specified arthritis
This range includes codes for other specified types of arthritis that may affect the shoulder, such as inflammatory arthritis.
Pain in joint
This range includes codes for joint pain, which may be used when arthritis is not confirmed.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M19.012 | Primary osteoarthritis, left shoulder | Use when degenerative changes are confirmed by imaging without a history of trauma. |
|
| M19.112 | Post-traumatic osteoarthritis, left shoulder | Use when arthritis is secondary to a documented traumatic event. |
|
| M13.812 | Other specified arthritis, left shoulder | Use for inflammatory arthritis types not specified elsewhere. |
|
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 left shoulder arthritis
Essential facts and insights about Left Shoulder Arthritis
Primary ICD-10-CM Codes for left shoulder arthritis
Decision Criteria
clinical Criteria
- Confirmed degenerative changes on imaging without trauma history.
Applicable To
- Degenerative joint disease of left shoulder
Excludes
- Post-traumatic osteoarthritis (M19.112)
Clinical Validation Requirements
- X-ray showing joint space narrowing
- Absence of trauma history
Code-Specific Risks
- Risk of unspecified laterality leading to claim denials.
Coding Notes
- Ensure documentation specifies 'primary' osteoarthritis and confirms degenerative changes via imaging.
M19.112 - Post-traumatic osteoarthritis, left shoulder
Use when arthritis is secondary to a documented traumatic event.
Applicable To
- Arthritis due to previous injury
Excludes
- Primary osteoarthritis (M19.012)
Clinical Validation Requirements
- Documented history of trauma
- Imaging showing joint degeneration
Coding Notes
Ensure trauma history is clearly documented, including date and type of injury.
M13.812 - Other specified arthritis, left shoulder
Use for inflammatory arthritis types not specified elsewhere.
Applicable To
- Inflammatory arthritis without rheumatoid factor
Excludes
- Rheumatoid arthritis (M05.11)
Clinical Validation Requirements
- Synovitis on ultrasound
- Elevated inflammatory markers
Coding Notes
Document specific type of arthritis and confirm with lab results.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Pain in left shoulder
M25.512Differential 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 Left Shoulder Arthritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M19.012.
Impact
Clinical: Leads to vague clinical records., Regulatory: Non-compliance with coding standards., Financial: Increased risk of claim denials.
Mitigation Strategy
Always document laterality and type., Review imaging and history for specificity.
Impact
Reimbursement: Claims may be denied if laterality is not specified., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate data collection and reporting.
Mitigation Strategy
Always specify left or right shoulder in documentation.
Impact
Reimbursement: Incorrect coding may lead to claim rejections., Compliance: Potential audit issues due to incorrect coding., Data Quality: Misleading clinical data regarding patient history.
Mitigation Strategy
Ensure trauma history is documented for post-traumatic codes.
Impact
Failure to specify laterality can lead to audit flags.
Mitigation Strategy
Implement mandatory fields in EHR 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 Left Shoulder Arthritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Left Shoulder Arthritis
Use these documentation templates to ensure complete and accurate documentation for Left Shoulder Arthritis. These templates include all required elements for proper coding and billing.
Chronic shoulder pain evaluation
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Diagnosis and treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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