ICD-10 Coding for Shoulder Injury(S46.011A, S42.255A)
Complete ICD-10-CM coding and documentation guide for Shoulder Injury. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Shoulder Injury
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S46.011A | Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial encounter | Use for acute traumatic tears with MRI confirmation. |
|
| S42.255A | Displaced fracture of surgical neck of left humerus, initial encounter | Use for initial encounter of displaced fractures confirmed by 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 injury
Essential facts and insights about Shoulder Injury
Primary ICD-10-CM Codes for shoulder injury
Decision Criteria
clinical Criteria
- MRI shows full-thickness tear
documentation Criteria
- Document acute onset and mechanism of injury
Applicable To
- Acute rotator cuff tear
Excludes
- Chronic rotator cuff tear (M75.121)
Clinical Validation Requirements
- MRI confirmation of full-thickness tear
- Positive drop arm test
Code-Specific Risks
- Ensure laterality is documented
- Confirm acute nature with clinical history
Coding Notes
- Ensure documentation specifies acute trauma and MRI findings.
S42.255A - Displaced fracture of surgical neck of left humerus, initial encounter
Use for initial encounter of displaced fractures confirmed by imaging.
Applicable To
- Displaced surgical neck fracture
Excludes
- Nondisplaced fracture (S42.256A)
Clinical Validation Requirements
- X-ray confirmation of displacement
- Mechanism of injury documented
Coding Notes
Ensure encounter type and fracture specifics are documented.
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 Injury to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S46.011A.
Impact
Clinical: Inadequate understanding of injury context., Regulatory: Potential non-compliance with documentation standards., Financial: Risk of claim denials due to insufficient detail.
Mitigation Strategy
Use structured templates that include injury mechanism fields, Train staff on the importance of comprehensive documentation
Impact
Reimbursement: Claims may be denied or delayed., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate patient records and statistics.
Mitigation Strategy
Always specify left or right shoulder in documentation.
Impact
Reimbursement: Incorrect DRG assignment affecting payment., Compliance: Non-compliance with coding standards., Data Quality: Errors in patient care tracking and reporting.
Mitigation Strategy
Ensure the correct 7th character is used: 'A' for initial, 'D' for subsequent, 'S' for sequela.
Impact
Failure to document all required elements can lead to audit findings.
Mitigation Strategy
Use comprehensive templates and conduct regular documentation audits.
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 Injury, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Shoulder Injury
Use these documentation templates to ensure complete and accurate documentation for Shoulder Injury. These templates include all required elements for proper coding and billing.
Post-operative shoulder injury follow-up
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical exam findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Shoulder Injury? Ask your questions below.