ICD-10 Coding for Shoulder Arthroscopy(M75.121, S43.431A)
Complete ICD-10-CM coding and documentation guide for Shoulder Arthroscopy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Shoulder Arthroscopy
M75-M75.9Primary Range
Shoulder lesions
This range includes conditions commonly treated with shoulder arthroscopy, such as rotator cuff tear and impingement syndrome.
Dislocations and sprains of joints and ligaments of shoulder girdle
Includes acute injuries often addressed with arthroscopic procedures, such as Bankart lesions.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M75.121 | Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic | Use when imaging confirms a partial tear and conservative treatment has failed. |
|
| S43.431A | Anterior dislocation of right shoulder joint, initial encounter | Use for initial treatment of acute anterior dislocation. |
|
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 arthroscopy
Essential facts and insights about Shoulder Arthroscopy
Primary ICD-10-CM Codes for shoulder arthroscopy
Decision Criteria
clinical Criteria
- MRI confirmation of partial tear
Applicable To
- Partial-thickness tear of right rotator cuff
Excludes
- Complete rotator cuff tear (M75.121)
Clinical Validation Requirements
- MRI showing partial-thickness tear
- Clinical signs of shoulder pain and weakness
Code-Specific Risks
- Misclassification as complete tear
Coding Notes
- Ensure laterality is documented clearly.
S43.431A - Anterior dislocation of right shoulder joint, initial encounter
Use for initial treatment of acute anterior dislocation.
Applicable To
- Acute anterior dislocation
Excludes
- Chronic instability (M24.411)
Clinical Validation Requirements
- Positive apprehension test
- Imaging confirming dislocation
Coding Notes
Ensure encounter type is documented (initial, subsequent, sequela).
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Presence of right artificial shoulder joint
Z96.611Differential 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 Arthroscopy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M75.121.
Impact
Clinical: Potential for incorrect treatment, Regulatory: Increased audit risk, Financial: Claim denials or delays
Mitigation Strategy
Use templates that prompt for laterality, Regular training on documentation standards
Impact
Reimbursement: Denial of payment for unbundled services, Compliance: Potential audit risk, Data Quality: Inaccurate representation of services provided
Mitigation Strategy
Ensure that debridement codes are not reported separately when included in a primary procedure.
Impact
Using modifiers incorrectly can lead to audits and denials.
Mitigation Strategy
Ensure proper training on modifier use and regular audits of coding practices.
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 Arthroscopy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Shoulder Arthroscopy
Use these documentation templates to ensure complete and accurate documentation for Shoulder Arthroscopy. These templates include all required elements for proper coding and billing.
Arthroscopic Bankart repair
Specialty: Orthopedic SurgeryRequired Elements
- Indications for surgery
- Findings during arthroscopy
- Details of repair technique
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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