ICD-10 Coding for Right Shoulder Sprain(S43.491A, S43.401A)
Complete ICD-10-CM coding and documentation guide for Right Shoulder Sprain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Shoulder Sprain
S43.4Primary Range
Sprain and strain of shoulder joint and ligaments
This range includes all sprains and strains related to the shoulder joint, with specific codes for different anatomical structures.
Injury of muscle and tendon of the rotator cuff of shoulder
This range is relevant for differentiating between sprains and strains, particularly involving the rotator cuff.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S43.491A | Other sprain of right shoulder joint, initial encounter | Use when documentation specifies a generalized sprain of the right shoulder without specific ligament identification. |
|
| S43.401A | Unspecified sprain of right acromioclavicular joint, initial encounter | Use when documentation specifies an AC joint injury with positive physical exam findings. |
|
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 sprain
Essential facts and insights about Right Shoulder Sprain
Primary ICD-10-CM Codes for right shoulder sprain
Decision Criteria
clinical Criteria
- Presence of diffuse ligamentous injury without specific structure identified.
documentation Criteria
- Documentation lacks specific ligament involvement.
Applicable To
- Diffuse ligamentous injury of right shoulder
Excludes
- Strain of muscle or tendon of the rotator cuff (S46.011A)
Clinical Validation Requirements
- Positive scarf test
- Limited abduction <90°
- MRI showing capsular edema
Code-Specific Risks
- Confusion with rotator cuff strain
- Incorrect 7th character usage
Coding Notes
- Ensure laterality and specific ligament involvement are documented.
S43.401A - Unspecified sprain of right acromioclavicular joint, initial encounter
Use when documentation specifies an AC joint injury with positive physical exam findings.
Applicable To
- Right AC joint sprain
Excludes
- Rotator cuff capsule sprain (S43.421A)
Clinical Validation Requirements
- Tenderness over right AC joint
- Positive cross-arm test
Coding Notes
Ensure AC joint involvement is clearly documented.
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 Sprain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S43.491A.
Impact
Clinical: Leads to vague clinical records., Regulatory: Non-compliance with coding specificity requirements., Financial: Potential for reduced reimbursement due to lack of specificity.
Mitigation Strategy
Train staff on the importance of documenting specific anatomical details., Use coding software that prompts for specificity.
Impact
Reimbursement: Incorrect coding can lead to claim denials or incorrect DRG assignment., Compliance: Misclassification affects compliance with coding guidelines., Data Quality: Impacts the accuracy of clinical data and patient records.
Mitigation Strategy
Ensure documentation specifies whether the injury involves ligaments (sprain) or muscles/tendons (strain).
Impact
Risk of audits due to use of unspecified codes.
Mitigation Strategy
Ensure all documentation includes specific anatomical details and mechanism of injury.
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 Sprain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Shoulder Sprain
Use these documentation templates to ensure complete and accurate documentation for Right Shoulder Sprain. These templates include all required elements for proper coding and billing.
Emergency Department Visit for Right Shoulder Sprain
Specialty: Emergency MedicineRequired Elements
- Mechanism of injury
- Specific anatomical location
- Physical exam findings
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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