ICD-10 Coding for Right Shoulder Arthritis(M19.011, M13.811)
Complete ICD-10-CM coding and documentation guide for Right Shoulder Arthritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Shoulder Arthritis
M19.0-M19.9Primary Range
Osteoarthritis
This range includes codes for osteoarthritis, which is a common form of arthritis affecting the shoulder.
Other Specified Arthritis
This range covers other specified types of arthritis, including rheumatoid and post-traumatic arthritis.
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 confirmed by imaging and clinical examination. |
|
| M13.811 | Other specified arthritis, right shoulder | Use when arthritis is specified as rheumatoid or post-traumatic. |
|
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 shoulder arthritis
Essential facts and insights about Right Shoulder Arthritis
Primary ICD-10-CM Codes for right shoulder arthritis
Decision Criteria
clinical Criteria
- Confirmed by X-ray showing joint space narrowing
Applicable To
- Degenerative joint disease of the right shoulder
Clinical Validation Requirements
- X-ray showing joint space narrowing
- Presence of osteophytes
Code-Specific Risks
- Misclassification if imaging is not reviewed
Coding Notes
- Ensure imaging supports the diagnosis of osteoarthritis.
M13.811 - Other specified arthritis, right shoulder
Use when arthritis is specified as rheumatoid or post-traumatic.
Applicable To
- Rheumatoid arthritis of the right shoulder
- Post-traumatic arthritis of the right shoulder
Excludes
- Osteoarthritis (M19.0-)
Clinical Validation Requirements
- Rheumatoid factor or anti-CCP positive
- History of trauma for post-traumatic arthritis
Coding Notes
Ensure documentation specifies the type of arthritis.
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 Shoulder Arthritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M19.011.
Impact
Clinical: May affect treatment decisions, Regulatory: Non-compliance with coding standards, Financial: Potential for claim denials
Mitigation Strategy
Use templates for documentation, Educate providers on specificity
Impact
Reimbursement: May lead to lower reimbursement rates, Compliance: Non-compliance with coding guidelines, Data Quality: Reduces accuracy of clinical data
Mitigation Strategy
Ensure the primary diagnosis of arthritis is documented and coded.
Impact
Failure to specify laterality can lead to audit findings.
Mitigation Strategy
Implement mandatory fields in EHR for 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 Right Shoulder Arthritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Shoulder Arthritis
Use these documentation templates to ensure complete and accurate documentation for Right Shoulder Arthritis. These templates include all required elements for proper coding and billing.
Diagnosis of primary osteoarthritis in the right shoulder
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Specific diagnosis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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