ICD-10 Coding for Left Shoulder Injury(S43.52XA, S46.012A, S49.92XA, M25.512)
Complete ICD-10-CM coding and documentation guide for Left Shoulder Injury. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Left Shoulder Injury
S40-S49Primary Range
Injuries to the shoulder and upper arm
This range includes all injuries specific to the shoulder and upper arm, including sprains, strains, and unspecified injuries.
Other joint disorders, not elsewhere classified
This range includes codes for joint pain and other non-specific joint disorders.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S43.52XA | Sprain of left acromioclavicular joint, initial encounter | Use when a sprain of the left AC joint is confirmed by clinical examination and imaging. |
|
| S46.012A | Strain of muscle(s) and tendon(s) of the rotator cuff of left shoulder, initial encounter | Use when a rotator cuff strain is confirmed by clinical examination and MRI. |
|
| S49.92XA | Unspecified injury of left shoulder and upper arm, initial encounter | Use when the specific nature of the shoulder injury cannot be determined. |
|
| M25.512 | Pain in left shoulder | Use when shoulder pain is present without a specific injury diagnosis. |
|
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 injury
Essential facts and insights about Left Shoulder Injury
Primary ICD-10-CM Codes for left shoulder injury
Decision Criteria
clinical Criteria
- Presence of AC joint tenderness and positive imaging findings
coding Criteria
- Initial encounter for the injury
Applicable To
- Sprain of left AC joint
Excludes
- Fracture of clavicle
Clinical Validation Requirements
- Tenderness over left AC joint
- Positive cross-body adduction test
- X-ray shows AC joint widening
Code-Specific Risks
- Incorrect 7th character usage for follow-up visits
Coding Notes
- Ensure the 7th character reflects the encounter type: 'A' for initial, 'D' for subsequent, 'S' for sequela.
S46.012A - Strain of muscle(s) and tendon(s) of the rotator cuff of left shoulder, initial encounter
Use when a rotator cuff strain is confirmed by clinical examination and MRI.
Applicable To
- Rotator cuff tear
Excludes
- Complete rupture of rotator cuff
Clinical Validation Requirements
- Weakness on empty can test
- MRI-confirmed supraspinatus tear
- Pain with resisted abduction
Coding Notes
Ensure documentation supports the specific muscle or tendon involved.
S49.92XA - Unspecified injury of left shoulder and upper arm, initial encounter
Use when the specific nature of the shoulder injury cannot be determined.
Applicable To
- Unspecified shoulder injury
Excludes
- Specific injuries like fractures or dislocations
Clinical Validation Requirements
- Generalized shoulder pain without specific diagnosis
Coding Notes
Consider more specific codes if further diagnostic information becomes available.
M25.512 - Pain in left shoulder
Use when shoulder pain is present without a specific injury diagnosis.
Applicable To
- Shoulder pain without structural injury
Excludes
- Pain due to specific injuries like sprains or tears
Clinical Validation Requirements
- Localized left shoulder pain without structural abnormality on imaging
Coding Notes
Ensure documentation clearly indicates the absence of structural injury.
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 Left Shoulder Injury to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S43.52XA.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.
Mitigation Strategy
Always document how the injury occurred., Use templates to ensure completeness.
Impact
Reimbursement: May result in lower reimbursement rates., Compliance: Could lead to non-compliance with coding guidelines., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Use specific injury codes like S43.52XA or S46.012A when applicable.
Impact
Reimbursement: Incorrect billing for encounter type., Compliance: Non-compliance with ICD-10 coding standards., Data Quality: Inaccurate tracking of patient care episodes.
Mitigation Strategy
Ensure the 7th character reflects the encounter type: 'A' for initial, 'D' for subsequent, 'S' for sequela.
Impact
Frequent use of unspecified codes like S49.92XA can trigger audits.
Mitigation Strategy
Use specific codes whenever possible and ensure documentation supports 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 Left Shoulder Injury, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Left Shoulder Injury
Use these documentation templates to ensure complete and accurate documentation for Left Shoulder Injury. These templates include all required elements for proper coding and billing.
Initial evaluation of left shoulder injury
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Specific pain location
- Physical exam findings
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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