ICD-10 Coding for Rotator Cuff Repair(S46.011A, M75.111)
Complete ICD-10-CM coding and documentation guide for Rotator Cuff Repair. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Rotator Cuff Repair
S46.0Primary Range
Injury of muscle and tendon of the rotator cuff of shoulder
This range includes codes for traumatic injuries to the rotator cuff, which are primary for acute tears.
Rotator cuff syndrome
This range includes codes for non-traumatic rotator cuff conditions, relevant for chronic degenerative tears.
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 for acute traumatic tears of the right rotator cuff. |
|
| M75.111 | Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic | Use for chronic degenerative tears of the right rotator cuff. |
|
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 traumatic rotator cuff tear
Essential facts and insights about Rotator Cuff Repair
Primary ICD-10-CM Codes for rotator cuff repair
Decision Criteria
clinical Criteria
- Presence of trauma leading to the tear
Applicable To
- Traumatic tear of right rotator cuff
Excludes
- Non-traumatic rotator cuff tear
Clinical Validation Requirements
- Documented mechanism of injury
- Imaging confirming acute tear
Code-Specific Risks
- Incorrectly coding chronic tears as acute
Coding Notes
- Ensure documentation specifies the traumatic nature of the tear.
M75.111 - Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic
Use for chronic degenerative tears of the right rotator cuff.
Applicable To
- Chronic degenerative tear of right rotator cuff
Excludes
- Traumatic rotator cuff tear
Clinical Validation Requirements
- Chronic shoulder pain history
- Imaging showing degenerative changes
Coding Notes
Ensure documentation reflects the chronic nature and absence of trauma.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Patient's intentional underdosing of medication regimen for other reason
Z91.128Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic
M75.111Strain 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 Repair 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 clinical records, Regulatory: Potential for audit discrepancies, Financial: Denied claims or incorrect reimbursement
Mitigation Strategy
Use templates that prompt for tear chronicity, Educate staff on documentation requirements
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: May result in audits if documentation does not support the code., Data Quality: Affects the accuracy of clinical data and patient records.
Mitigation Strategy
Base chronicity on the presence of trauma, not time since injury.
Impact
Missing laterality in documentation can lead to claim denials.
Mitigation Strategy
Implement mandatory fields for laterality in EHR templates.
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 Repair, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Rotator Cuff Repair
Use these documentation templates to ensure complete and accurate documentation for Rotator Cuff Repair. These templates include all required elements for proper coding and billing.
Arthroscopic repair of traumatic rotator cuff tear
Specialty: Orthopedic SurgeryRequired Elements
- Mechanism of injury
- Imaging results
- Repair technique
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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