ICD-10 Coding for Right Shoulder Osteoarthritis(M19.011)
Complete ICD-10-CM coding and documentation guide for Right Shoulder Osteoarthritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Shoulder Osteoarthritis
M19.0-M19.9Primary Range
Osteoarthritis
This range includes codes for primary and secondary osteoarthritis, specifying laterality and type.
Key Information: ICD-10 code for right shoulder osteoarthritis
Essential facts and insights about Right Shoulder Osteoarthritis
Primary ICD-10-CM Code for right shoulder oa
Decision Criteria
clinical Criteria
- Imaging confirms degenerative changes without trauma history.
coding Criteria
- Code M19.011 is used for primary OA without trauma.
documentation Criteria
- Document 'primary osteoarthritis' and 'right shoulder' explicitly.
Applicable To
- Degenerative joint disease of right shoulder
Clinical Validation Requirements
- X-ray showing joint space narrowing
- Presence of osteophytes
- Subchondral sclerosis
Code-Specific Risks
- Risk of incorrect coding if imaging is not documented
- Confusion with post-traumatic osteoarthritis
Coding Notes
- Ensure imaging findings are documented to support the diagnosis of primary osteoarthritis.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Osteoarthritis 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 ambiguous diagnosis., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Use templates that prompt for laterality and type., Regular training on documentation standards.
Impact
Reimbursement: Incorrect coding may lead to lower reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Link pain to OA: 'Pain secondary to primary OA (M19.011)'.
Impact
Coding OA without imaging confirmation increases audit risk.
Mitigation Strategy
Ensure all OA diagnoses are supported by imaging reports.
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 Osteoarthritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Shoulder Osteoarthritis
Use these documentation templates to ensure complete and accurate documentation for Right Shoulder Osteoarthritis. These templates include all required elements for proper coding and billing.
Orthopedic Progress Note
Specialty: OrthopedicsRequired Elements
- Patient history
- Imaging findings
- Clinical assessment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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