ICD-10 Coding for Rotator Cuff Injury(S46.011A, M75.121)
Complete ICD-10-CM coding and documentation guide for Rotator Cuff Injury. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Rotator Cuff Injury
S46.0-S46.9Primary Range
Injury of muscle and tendon of the shoulder girdle
This range includes traumatic injuries to the rotator cuff, which are common in acute shoulder injuries.
Shoulder lesions
This range includes non-traumatic rotator cuff tears, often due to degenerative changes.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S46.011A | Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial encounter | Use when there is a documented traumatic event leading to a rotator cuff tear. |
|
| M75.121 | Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic | Use when the tear is due to degenerative changes without a specific traumatic event. |
|
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 injury
Essential facts and insights about Rotator Cuff Injury
Primary ICD-10-CM Codes for rotator cuff injury
Decision Criteria
clinical Criteria
- Presence of acute traumatic event leading to shoulder pain
documentation Criteria
- MRI findings consistent with acute tear
Applicable To
- Acute traumatic rotator cuff tear
Excludes
- Non-traumatic rotator cuff tear (M75.1-)
Clinical Validation Requirements
- MRI showing acute hematoma at tendon insertion
- Documented mechanism of injury such as fall
Code-Specific Risks
- Misclassification as non-traumatic if trauma is not documented
Coding Notes
- Ensure the documentation clearly states the traumatic nature of the injury.
M75.121 - Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic
Use when the tear is due to degenerative changes without a specific traumatic event.
Applicable To
- Degenerative rotator cuff tear
Excludes
- Traumatic rotator cuff tear (S46.0-)
Clinical Validation Requirements
- X-ray showing superior humeral migration
- Ultrasound showing hypoechoic tendon defect
Coding Notes
Ensure documentation supports degenerative nature of the tear.
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.
Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic
M75.121Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial encounter
S46.011ADocumentation & Coding Risks
Avoid these common documentation and coding issues when documenting Rotator Cuff Injury to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S46.011A.
Impact
Clinical: Inaccurate treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Always specify right or left shoulder in documentation, Use templates that prompt for laterality
Impact
Reimbursement: Incorrect coding may lead to denied claims or reduced reimbursement., Compliance: Failure to comply with ICD-10 coding guidelines., Data Quality: Inaccurate data on the nature of the injury.
Mitigation Strategy
Use S46.011A with appropriate external cause codes
Impact
Using the wrong 7th character can lead to audit flags.
Mitigation Strategy
Educate staff on the importance of 7th character 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 Rotator Cuff Injury, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Rotator Cuff Injury
Use these documentation templates to ensure complete and accurate documentation for Rotator Cuff Injury. These templates include all required elements for proper coding and billing.
Post-Operative Follow-Up
Specialty: OrthopedicsRequired Elements
- Patient's subjective report
- Objective findings
- Assessment
- Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Rotator Cuff Injury? Ask your questions below.