ICD-10 Coding for Right Clavicle Pain(S42.021A, M25.511)
Complete ICD-10-CM coding and documentation guide for Right Clavicle Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Clavicle Pain
S42.0-S42.9Primary Range
Fracture of shoulder and upper arm
Includes specific codes for clavicle fractures, which are primary for right clavicle pain due to trauma.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S42.021A | Displaced fracture of shaft of right clavicle, initial encounter | Use when there is a confirmed displaced fracture of the right clavicle shaft. |
|
| M25.511 | Pain in right shoulder | Use when pain is present without a confirmed fracture. |
|
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 right clavicle pain
Essential facts and insights about Right Clavicle Pain
Primary ICD-10-CM Codes for right clavicle pain
Decision Criteria
clinical Criteria
- Presence of trauma and imaging confirmation of displacement
Applicable To
- Displaced fracture of right clavicle shaft
Excludes
- Non-displaced fracture of right clavicle
Clinical Validation Requirements
- X-ray confirmation of displaced fracture
- History of trauma
Code-Specific Risks
- Ensure documentation specifies 'displaced' and 'shaft' to avoid denials.
Coding Notes
- Ensure imaging supports the diagnosis of a displaced fracture.
M25.511 - Pain in right shoulder
Use when pain is present without a confirmed fracture.
Applicable To
- Pain in right shoulder joint
Excludes
- Fracture-related pain
Clinical Validation Requirements
- Pain scale documentation
- Absence of fracture on imaging
Coding Notes
Document pain characteristics and any functional limitations.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Pain in right shoulder
M25.511Differential 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 Right Clavicle Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S42.021A.
Impact
Clinical: May lead to incorrect treatment., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always document the side of the body affected., Use templates that prompt for laterality.
Impact
Reimbursement: Specific codes may lead to higher reimbursement rates., Compliance: Improves compliance with coding guidelines., Data Quality: Enhances data accuracy for clinical records.
Mitigation Strategy
Use specific codes like S42.021A for better specificity.
Impact
Using unspecified codes increases audit risk.
Mitigation Strategy
Ensure documentation supports specific 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 Right Clavicle Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Clavicle Pain
Use these documentation templates to ensure complete and accurate documentation for Right Clavicle Pain. These templates include all required elements for proper coding and billing.
Emergency Department Visit for Clavicle Fracture
Specialty: OrthopedicsRequired Elements
- Chief Complaint
- History of Present Illness
- Review of Systems
- Physical Exam
- Imaging Results
- Assessment and Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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