ICD-10 Coding for Right Shoulder Injury(S43.401A, M25.511)
Complete ICD-10-CM coding and documentation guide for Right Shoulder Injury. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Shoulder Injury
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S43.401A | Sprain of unspecified ligament of right shoulder, initial encounter | Use for initial encounter of acute right shoulder sprain. |
|
| M25.511 | Pain in right shoulder | Use for chronic pain without a specific injury. |
|
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 injury
Essential facts and insights about Right Shoulder Injury
Primary ICD-10-CM Codes for right shoulder injury
Decision Criteria
clinical Criteria
- Presence of acute trauma with ligament tenderness
documentation Criteria
- Documented initial encounter with specific ligament
Applicable To
- Right AC joint sprain
Excludes
- Chronic shoulder pain (M25.511)
Clinical Validation Requirements
- Mechanism of injury: FOOSH
- Tenderness at AC joint
Code-Specific Risks
- Incorrect laterality
- Missing encounter type
Coding Notes
- Ensure to document the mechanism of injury and specific ligament involved.
M25.511 - Pain in right shoulder
Use for chronic pain without a specific injury.
Applicable To
- Chronic shoulder pain
Excludes
- Acute shoulder injury (S40-S49)
Clinical Validation Requirements
- Pain duration >3 months
- No acute injury on imaging
Coding Notes
Ensure chronicity is documented and no acute injury is present.
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 Injury to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S43.401A.
Impact
Clinical: Ambiguity in patient records., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always document 'right' or 'left' for shoulder injuries.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use S-code with 7th character A for acute conditions.
Impact
Using chronic pain codes for acute injuries can lead to audit flags.
Mitigation Strategy
Educate staff on proper code selection based on encounter 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 Right Shoulder Injury, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Shoulder Injury
Use these documentation templates to ensure complete and accurate documentation for Right Shoulder Injury. These templates include all required elements for proper coding and billing.
Emergency Department Visit for Right Shoulder Injury
Specialty: Emergency MedicineRequired Elements
- Mechanism of injury
- Specific ligament or area affected
- Initial vs. subsequent encounter
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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