ICD-10 Coding for Shoulder Arthritis(M19.011, M19.012)
Complete ICD-10-CM coding and documentation guide for Shoulder Arthritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Shoulder Arthritis
M19.01-M19.02Primary Range
Primary osteoarthritis of shoulder
This range covers primary osteoarthritis affecting the shoulder, which is the most common form of shoulder arthritis.
Post-traumatic osteoarthritis of shoulder
This range is used when osteoarthritis is due to previous trauma or injury to the shoulder.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M19.011 | Primary osteoarthritis, right shoulder | Use when imaging confirms primary osteoarthritis in the right shoulder without prior trauma. |
|
| M19.012 | Primary osteoarthritis, left shoulder | Use when imaging confirms primary osteoarthritis in the left shoulder without prior trauma. |
|
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 shoulder arthritis
Essential facts and insights about Shoulder Arthritis
Primary ICD-10-CM Codes for shoulder arthritis
Decision Criteria
clinical Criteria
- Confirmed degenerative changes on imaging
documentation Criteria
- No documented history of shoulder trauma
Applicable To
- Degenerative joint disease of right shoulder
Excludes
- Post-traumatic osteoarthritis (M19.11-)
Clinical Validation Requirements
- X-ray showing joint space narrowing and osteophytes
- No history of trauma or surgery
Code-Specific Risks
- Incorrectly coding as unspecified when laterality is known
Coding Notes
- Ensure documentation specifies primary osteoarthritis without trauma history.
M19.012 - Primary osteoarthritis, left shoulder
Use when imaging confirms primary osteoarthritis in the left shoulder without prior trauma.
Applicable To
- Degenerative joint disease of left shoulder
Excludes
- Post-traumatic osteoarthritis (M19.12-)
Clinical Validation Requirements
- X-ray showing joint space narrowing and osteophytes
- No history of trauma or surgery
Coding Notes
Ensure documentation specifies primary osteoarthritis without trauma history.
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 Shoulder Arthritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M19.011.
Impact
Clinical: May lead to incorrect diagnosis and treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Use structured documentation templates., Ensure imaging findings are included in the patient record.
Impact
Reimbursement: May lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Always document and code the specific shoulder affected.
Impact
Failure to document laterality can lead to audit findings.
Mitigation Strategy
Implement mandatory fields in EHR for laterality.
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 Shoulder Arthritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Shoulder Arthritis
Use these documentation templates to ensure complete and accurate documentation for Shoulder Arthritis. These templates include all required elements for proper coding and billing.
Chronic shoulder pain with suspected osteoarthritis
Specialty: OrthopedicsRequired Elements
- Patient history
- Imaging results
- Physical examination findings
- Pain assessment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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