ICD-10 Coding for Rotator Cuff Arthropathy(M75.122, M19.91)
Complete ICD-10-CM coding and documentation guide for Rotator Cuff Arthropathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Rotator Cuff Arthropathy
M75.1-M75.12Primary Range
Non-traumatic rotator cuff tear or rupture
Primary range for coding non-traumatic rotator cuff tears, including complete tears associated with arthropathy.
Unspecified osteoarthritis
Used to code the osteoarthritis component of rotator cuff arthropathy.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M75.122 | Complete rotator cuff tear or rupture of left shoulder, not specified as traumatic | Use when a complete non-traumatic tear of the left rotator cuff is documented. |
|
| M19.91 | Unspecified osteoarthritis | Use when osteoarthritis is present as a result of rotator cuff arthropathy. |
|
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 rotator cuff arthropathy
Essential facts and insights about Rotator Cuff Arthropathy
Primary ICD-10-CM Codes for rotator cuff arthropathy
Decision Criteria
clinical Criteria
- Presence of a complete tear on imaging without trauma history
Applicable To
- Complete non-traumatic tear of left shoulder
Excludes
- Traumatic rotator cuff tear (S46.01-)
Clinical Validation Requirements
- MRI or X-ray showing complete tear
- Documentation of non-traumatic etiology
Code-Specific Risks
- Misclassification as traumatic
- Omission of associated arthropathy code
Coding Notes
- Ensure documentation clearly differentiates between traumatic and non-traumatic causes.
M19.91 - Unspecified osteoarthritis
Use when osteoarthritis is present as a result of rotator cuff arthropathy.
Applicable To
- Osteoarthritis secondary to rotator cuff tear
Excludes
- Primary osteoarthritis without rotator cuff involvement
Clinical Validation Requirements
- Imaging showing joint degeneration
- Linkage to rotator cuff pathology
Coding Notes
Ensure osteoarthritis is documented as secondary to the rotator cuff condition.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Impingement syndrome of shoulder
M75.41Differential 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 Rotator Cuff Arthropathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M75.122.
Impact
Clinical: Misrepresentation of the patient's condition., Regulatory: Potential non-compliance with coding standards., Financial: Possible underpayment due to incomplete coding.
Mitigation Strategy
Ensure thorough documentation of imaging findings, Explicitly link osteoarthritis to the rotator cuff tear
Impact
Reimbursement: Incomplete coding may lead to lower reimbursement rates., Compliance: Failure to comply with coding guidelines., Data Quality: Inaccurate representation of patient condition in medical records.
Mitigation Strategy
Always code both the tear and the associated osteoarthritis when RCTA is diagnosed.
Impact
Omitting the osteoarthritis code when coding RCTA.
Mitigation Strategy
Implement a checklist to ensure both tear and arthritis are coded.
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 Rotator Cuff Arthropathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Rotator Cuff Arthropathy
Use these documentation templates to ensure complete and accurate documentation for Rotator Cuff Arthropathy. These templates include all required elements for proper coding and billing.
Chronic RCTA with osteoarthritis
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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