ICD-10 Coding for Rotator Cuff Tendinopathy(M75.31, M75.32)
Complete ICD-10-CM coding and documentation guide for Rotator Cuff Tendinopathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Rotator Cuff Tendinopathy
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M75.31 | Supraspinatus tendinitis | Use when supraspinatus tendon is specifically involved with tendinitis. |
|
| M75.32 | Infraspinatus tendinitis | Use when infraspinatus tendon is specifically involved with tendinitis. |
|
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 tendinopathy
Essential facts and insights about Rotator Cuff Tendinopathy
Primary ICD-10-CM Codes for rotator cuff tendinopathy
Decision Criteria
clinical Criteria
- Pain with overhead abduction and positive Neer test
Applicable To
- Pain localized to supraspinatus tendon
Excludes
- Full-thickness rotator cuff tear
Clinical Validation Requirements
- Positive Hawkins or Jobe tests
- Ultrasound showing supraspinatus tendon thickening
Code-Specific Risks
- Misclassification as unspecified shoulder pain
Coding Notes
- Ensure laterality is specified to avoid unspecified coding.
M75.32 - Infraspinatus tendinitis
Use when infraspinatus tendon is specifically involved with tendinitis.
Applicable To
- Pain on resisted external rotation
Excludes
- Full-thickness rotator cuff tear
Clinical Validation Requirements
- Tenderness at posterior shoulder
- MRI showing infraspinatus signal changes
Coding Notes
Document specific tendon involvement to avoid unspecified coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Rotator Cuff Tendinopathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M75.31.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims or reduced reimbursement.
Mitigation Strategy
Use templates that prompt for specific tendon documentation., Regular training on documentation standards.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of health records.
Mitigation Strategy
Always specify laterality in documentation and coding.
Impact
Using unspecified codes when specific codes are available.
Mitigation Strategy
Implement regular audits and training on specific coding.
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 Tendinopathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Rotator Cuff Tendinopathy
Use these documentation templates to ensure complete and accurate documentation for Rotator Cuff Tendinopathy. These templates include all required elements for proper coding and billing.
Orthopedic Evaluation
Specialty: OrthopedicsRequired Elements
- Subjective: Patient's description of pain and activities affected.
- Objective: Physical exam findings, including special tests.
- Imaging: Results confirming tendinopathy.
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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