ICD-10 Coding for Rotator Cuff Syndrome(M75.111, S46.011A)
Complete ICD-10-CM coding and documentation guide for Rotator Cuff Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Rotator Cuff Syndrome
M75.1-M75.2Primary Range
Rotator cuff syndrome and related shoulder lesions
This range includes codes for both traumatic and degenerative rotator cuff conditions.
Injury of muscle and tendon of the rotator cuff of shoulder
This range is used for traumatic injuries to 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 |
|---|---|---|---|
| M75.111 | Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic | Use for non-traumatic partial tears of the right shoulder. |
|
| 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 shoulder. |
|
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 syndrome
Essential facts and insights about Rotator Cuff Syndrome
Primary ICD-10-CM Codes for rotator cuff syndrome
Decision Criteria
clinical Criteria
- MRI shows partial-thickness tear
documentation Criteria
- Specify laterality and tear type
Applicable To
- Partial tear of rotator cuff
Excludes
- Complete rotator cuff tear (M75.121)
Clinical Validation Requirements
- MRI showing partial-thickness tear
- Positive Neer or Hawkins test
Code-Specific Risks
- Misclassification as complete tear
Coding Notes
- Ensure documentation specifies partial vs. complete tear.
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 shoulder.
Applicable To
- Acute traumatic tear
Excludes
- Chronic degenerative tear (M75.1-)
Clinical Validation Requirements
- History of trauma
- MRI showing acute tear
Coding Notes
Ensure documentation includes the traumatic event.
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 Rotator Cuff Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M75.111.
Impact
Clinical: Leads to incorrect diagnosis coding., Regulatory: May result in audit issues., Financial: Can cause claim denials.
Mitigation Strategy
Always ask about recent trauma during patient history., Document any reported incidents clearly.
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.
Impact
Lack of documentation for traumatic events leading to rotator cuff tears.
Mitigation Strategy
Implement a checklist for trauma history in patient evaluations.
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 Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Rotator Cuff Syndrome
Use these documentation templates to ensure complete and accurate documentation for Rotator Cuff Syndrome. These templates include all required elements for proper coding and billing.
Orthopedic evaluation for suspected rotator cuff tear
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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