ICD-10 Coding for Left Shoulder Osteoarthritis(M19.012, M19.112)
Complete ICD-10-CM coding and documentation guide for Left Shoulder Osteoarthritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Left Shoulder Osteoarthritis
M19.0-M19.9Primary Range
Osteoarthritis
This range includes codes for osteoarthritis affecting various joints, including the shoulder.
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 imaging confirms primary OA without trauma or underlying cause. |
|
| M19.112 | Post-traumatic osteoarthritis, left shoulder | Use when OA is directly linked to a prior traumatic event. |
|
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 osteoarthritis
Essential facts and insights about Left Shoulder Osteoarthritis
Primary ICD-10-CM Codes for left shoulder oa
Decision Criteria
clinical Criteria
- Confirmed by X-ray showing degenerative changes
documentation Criteria
- Explicit mention of 'primary osteoarthritis'
Applicable To
- Degenerative joint disease of left shoulder
Excludes
- Post-traumatic osteoarthritis (M19.112)
Clinical Validation Requirements
- Radiographic evidence of joint space narrowing
- Presence of osteophytes
Code-Specific Risks
- Incorrect use if trauma history is present
Coding Notes
- Ensure documentation specifies 'primary' to avoid defaulting to unspecified codes.
M19.112 - Post-traumatic osteoarthritis, left shoulder
Use when OA is directly linked to a prior traumatic event.
Applicable To
- OA due to previous shoulder injury
Excludes
- Primary osteoarthritis (M19.012)
Clinical Validation Requirements
- History of shoulder trauma
- Imaging showing post-traumatic changes
Coding Notes
Ensure trauma history is clearly documented to justify this code.
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 Osteoarthritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M19.012.
Impact
Clinical: May lead to incorrect treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials due to unspecified coding.
Mitigation Strategy
Always document laterality in clinical notes., Use templates that prompt for laterality.
Impact
Reimbursement: Claims may be denied for lack of specificity., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on bilateral conditions.
Mitigation Strategy
Use separate codes for each shoulder (M19.011 for right, M19.012 for left).
Impact
Use of unspecified codes like M19.019 can trigger audits.
Mitigation Strategy
Ensure documentation specifies laterality and type.
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 Osteoarthritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Left Shoulder Osteoarthritis
Use these documentation templates to ensure complete and accurate documentation for Left Shoulder Osteoarthritis. These templates include all required elements for proper coding and billing.
Orthopedic Evaluation for Left Shoulder OA
Specialty: OrthopedicsRequired Elements
- History of present illness
- Physical examination findings
- Imaging results
- Diagnosis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Left Shoulder Osteoarthritis? Ask your questions below.