ICD-10 Coding for Shoulder Impingement Syndrome(M75.41, M75.42)
Complete ICD-10-CM coding and documentation guide for Shoulder Impingement Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Shoulder Impingement Syndrome
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M75.41 | Impingement syndrome, right shoulder | Use when impingement is confirmed in the right shoulder through clinical tests and imaging. |
|
| M75.42 | Impingement syndrome, left shoulder | Use when impingement is confirmed in the left shoulder through clinical tests and imaging. |
|
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 impingement syndrome
Essential facts and insights about Shoulder Impingement Syndrome
Primary ICD-10-CM Codes for shoulder impingement syndrome
Decision Criteria
clinical Criteria
- Presence of shoulder pain with positive impingement tests
Applicable To
- Right shoulder impingement
Excludes
- Rotator cuff tear (M75.121)
Clinical Validation Requirements
- Positive Hawkins or Neer's test
- Imaging showing subacromial narrowing
Code-Specific Risks
- Incorrectly coding as general shoulder pain
Coding Notes
- Ensure laterality is documented to avoid unspecified coding.
M75.42 - Impingement syndrome, left shoulder
Use when impingement is confirmed in the left shoulder through clinical tests and imaging.
Applicable To
- Left shoulder impingement
Excludes
- Rotator cuff tear (M75.122)
Clinical Validation Requirements
- Positive Hawkins or Neer's test
- Imaging showing subacromial narrowing
Coding Notes
Ensure laterality is documented to avoid unspecified coding.
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.
Cervical radiculopathy
M54.2Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Shoulder Impingement Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M75.41.
Impact
Clinical: Ambiguity in treatment planning., Regulatory: Potential for audit issues., Financial: Possible claim denials.
Mitigation Strategy
Always document whether the right or left shoulder is affected.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Ensure clinical confirmation of impingement through tests and imaging before coding.
Impact
Using M25.511 instead of specific impingement codes.
Mitigation Strategy
Educate coders on the importance of specific diagnosis confirmation.
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 Impingement Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Shoulder Impingement Syndrome
Use these documentation templates to ensure complete and accurate documentation for Shoulder Impingement Syndrome. These templates include all required elements for proper coding and billing.
Orthopedic Evaluation for Shoulder Pain
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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