ICD-10 Coding for Osteoarthritis of the Shoulder(M19.011, M19.012)
Complete ICD-10-CM coding and documentation guide for Osteoarthritis of the 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 Shoulder
M19.01-M19.02Primary Range
Primary osteoarthritis of the shoulder
This range covers primary osteoarthritis affecting the shoulder, specifying laterality.
Post-traumatic osteoarthritis of the shoulder
This range is used when osteoarthritis is due to previous trauma to the shoulder.
Secondary osteoarthritis of the shoulder
This range applies when osteoarthritis is secondary to another condition, such as a rotator cuff tear.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M19.011 | Primary osteoarthritis, right shoulder | Use when primary osteoarthritis is diagnosed in the right shoulder without any underlying cause. |
|
| M19.012 | Primary osteoarthritis, left shoulder | Use when primary osteoarthritis is diagnosed in the left shoulder without any underlying cause. |
|
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: How do you code bilateral osteoarthritis of the shoulder?
Essential facts and insights about Osteoarthritis of the Shoulder
Primary ICD-10-CM Codes for osteoarthritis shoulder
Decision Criteria
clinical Criteria
- Confirmed diagnosis of primary OA in the right shoulder
Applicable To
- Degenerative joint disease of the right shoulder
Clinical Validation Requirements
- X-ray or MRI showing joint space narrowing
- Presence of osteophytes
Code-Specific Risks
- Incorrectly coding as unspecified if laterality is documented
Coding Notes
- Ensure laterality is documented to avoid unspecified coding.
M19.012 - Primary osteoarthritis, left shoulder
Use when primary osteoarthritis is diagnosed in the left shoulder without any underlying cause.
Applicable To
- Degenerative joint disease of the left shoulder
Excludes
- Post-traumatic osteoarthritis (M19.112)
- Secondary osteoarthritis (M19.212)
Clinical Validation Requirements
- X-ray or MRI showing joint space narrowing
- Presence of osteophytes
Coding Notes
Ensure laterality is documented to avoid unspecified coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Osteoarthritis of the 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: Ambiguity in treatment planning., Regulatory: Non-compliance with ICD-10 coding rules., Financial: Potential claim denials.
Mitigation Strategy
Train staff on the importance of documenting laterality., Use templates that prompt for laterality.
Impact
Reimbursement: Incorrect coding can lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records and data reporting.
Mitigation Strategy
Use two separate codes for each shoulder: M19.011 and M19.012.
Impact
Failure to document laterality can lead to audit findings.
Mitigation Strategy
Ensure all clinical documentation includes 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 Osteoarthritis of the Shoulder, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Osteoarthritis of the Shoulder
Use these documentation templates to ensure complete and accurate documentation for Osteoarthritis of the Shoulder. These templates include all required elements for proper coding and billing.
Primary Osteoarthritis of the Shoulder
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Treatment history
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Osteoarthritis of the Shoulder? Ask your questions below.