ICD-10 Coding for Osteoarthritis of the Right Shoulder(M19.011)
Complete ICD-10-CM coding and documentation guide for Osteoarthritis of the Right Shoulder. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Osteoarthritis of the Right Shoulder
M19.0-M19.9Primary Range
Other and unspecified osteoarthritis
This range includes codes for osteoarthritis affecting various joints, including the shoulder.
Key Information: ICD-10 code for osteoarthritis right shoulder
Essential facts and insights about Osteoarthritis of the Right Shoulder
Primary ICD-10-CM Code for osteoarthritis right shoulder
Decision Criteria
clinical Criteria
- Confirmed by imaging and absence of trauma history
documentation Criteria
- Explicit mention of 'right shoulder' and 'primary osteoarthritis'
Applicable To
- Degenerative joint disease of the right shoulder
- Osteoarthritis of the right shoulder
Clinical Validation Requirements
- X-ray showing joint space narrowing
- Presence of osteophytes
- Chronic shoulder pain without trauma history
Code-Specific Risks
- Incorrectly coding as unspecified shoulder osteoarthritis
- Failing to document laterality
Coding Notes
- Ensure documentation specifies 'primary' osteoarthritis and laterality.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Presence of right artificial shoulder joint
Z96.611Differential 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 Osteoarthritis of the Right Shoulder to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M19.011.
Impact
Clinical: Leads to vague clinical records., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always document laterality and specific type of osteoarthritis.
Impact
Reimbursement: May lead to claim denials or reduced payment., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Always specify 'right shoulder' in the diagnosis.
Impact
Failure to document laterality can lead to audit findings.
Mitigation Strategy
Implement mandatory fields for laterality in EHR systems.
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 Osteoarthritis of the Right Shoulder, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Osteoarthritis of the Right Shoulder
Use these documentation templates to ensure complete and accurate documentation for Osteoarthritis of the Right Shoulder. These templates include all required elements for proper coding and billing.
Orthopedic Evaluation for Shoulder Pain
Specialty: OrthopedicsRequired Elements
- Patient history
- Imaging results
- Physical exam findings
- Diagnosis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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