ICD-10 Coding for Rotator Cuff Rupture(S46.011A, M75.121)
Complete ICD-10-CM coding and documentation guide for Rotator Cuff Rupture. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Rotator Cuff Rupture
S46.0Primary Range
Injury of muscle(s) and tendon(s) of the rotator cuff of shoulder
This range covers traumatic injuries to the rotator cuff, including strains and tears.
Rotator cuff tear or rupture, not specified as traumatic
This range is used for non-traumatic, degenerative tears of 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 |
|---|---|---|---|
| S46.011A | Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial encounter | Use for initial encounter of traumatic rotator cuff tear on the right shoulder. |
|
| M75.121 | Non-traumatic complete tear of rotator cuff of right shoulder | 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 rotator cuff tear
Essential facts and insights about Rotator Cuff Rupture
Primary ICD-10-CM Codes for rotator cuff rupture
Decision Criteria
clinical Criteria
- Presence of acute injury mechanism
documentation Criteria
- Documentation of right shoulder involvement
Applicable To
- Traumatic tear of right rotator cuff
Excludes
- Non-traumatic rotator cuff tear (M75.121)
Clinical Validation Requirements
- Acute injury mechanism documented
- MRI showing acute changes like hematoma
Code-Specific Risks
- Incorrectly using for non-traumatic tears
Coding Notes
- Ensure documentation specifies traumatic nature and laterality.
M75.121 - Non-traumatic complete tear of rotator cuff of right shoulder
Use for chronic, degenerative tears of the right rotator cuff.
Applicable To
- Degenerative tear of right rotator cuff
Excludes
- Traumatic rotator cuff tear (S46.011A)
Clinical Validation Requirements
- MRI showing degenerative changes
- No recent trauma documented
Coding Notes
Ensure documentation specifies degenerative nature and laterality.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Encounter for other orthopedic aftercare
Z47.89Differential 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 Rupture to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S46.011A.
Impact
Clinical: Leads to incomplete patient records., Regulatory: May result in coding errors and audits., Financial: Can cause claim denials or delays.
Mitigation Strategy
Always document which shoulder is affected., Use templates that prompt for laterality.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Misclassification may result in compliance issues., Data Quality: Affects the accuracy of patient records.
Mitigation Strategy
Verify the presence of trauma in the patient's history before coding.
Impact
Inadequate documentation of trauma can lead to incorrect coding.
Mitigation Strategy
Ensure all trauma-related cases have detailed injury descriptions.
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 Rupture, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Rotator Cuff Rupture
Use these documentation templates to ensure complete and accurate documentation for Rotator Cuff Rupture. These templates include all required elements for proper coding and billing.
Post-operative follow-up for rotator cuff repair
Specialty: OrthopedicsRequired Elements
- Patient's subjective report
- Objective findings
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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