ICD-10 Coding for Shoulder Labrum Tear(S43.431A, M75.61)
Complete ICD-10-CM coding and documentation guide for Shoulder Labrum Tear. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Shoulder Labrum Tear
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S43.431A | Superior glenoid labrum lesion of right shoulder, initial encounter | Use for acute traumatic superior labral tears of the right shoulder during the initial encounter. |
|
| M75.61 | Tear of labrum of left shoulder | Use for chronic degenerative labrum tears without a recent traumatic event. |
|
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 labrum tear
Essential facts and insights about Shoulder Labrum Tear
Primary ICD-10-CM Codes for shoulder labrum tear
Decision Criteria
clinical Criteria
- Presence of acute trauma and positive MRI findings
Applicable To
- Acute traumatic SLAP tear
Excludes
- Degenerative labrum tear (M75.6)
Clinical Validation Requirements
- MRI with contrast showing superior labral tear
- Positive O’Brien’s test
Code-Specific Risks
- Incorrectly coding degenerative tears as traumatic
Coding Notes
- Ensure documentation specifies the mechanism of injury and confirms the tear type with imaging.
M75.61 - Tear of labrum of left shoulder
Use for chronic degenerative labrum tears without a recent traumatic event.
Applicable To
- Degenerative labrum tear
Excludes
- Traumatic labrum tear (S43.4)
Clinical Validation Requirements
- MRI showing degenerative changes without acute injury
Coding Notes
Document the chronic nature and absence of acute trauma.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Arthroscopy, shoulder, surgical; repair of SLAP lesion
29807Differential 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 Labrum Tear to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S43.431A.
Impact
Clinical: Leads to ambiguity in treatment plans., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always document right or left shoulder, Use templates to ensure completeness
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: May result in compliance issues during audits., Data Quality: Affects the accuracy of patient records.
Mitigation Strategy
Ensure documentation clearly differentiates between acute trauma and degenerative changes.
Impact
Coding degenerative tears as traumatic can lead to audits.
Mitigation Strategy
Ensure clear documentation of the chronic nature of the tear.
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 Labrum Tear, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Shoulder Labrum Tear
Use these documentation templates to ensure complete and accurate documentation for Shoulder Labrum Tear. These templates include all required elements for proper coding and billing.
Acute SLAP Tear
Specialty: OrthopedicsRequired Elements
- Mechanism of injury
- Physical exam findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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