ICD-10 Coding for Shoulder Osteoarthritis(M19.011, M19.012)
Complete ICD-10-CM coding and documentation guide for Shoulder Osteoarthritis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Shoulder Osteoarthritis
M19.01-M19.12Primary Range
Primary and secondary osteoarthritis of the shoulder
This range covers the primary and secondary osteoarthritis codes for the shoulder, specifying laterality.
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 primary OA is confirmed in the right shoulder without prior trauma. |
|
| M19.012 | Primary osteoarthritis, left shoulder | Use when primary OA is confirmed 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 bilateral shoulder osteoarthritis
Essential facts and insights about Shoulder Osteoarthritis
Primary ICD-10-CM Codes for shoulder osteoarthritis
Decision Criteria
clinical Criteria
- Confirmed primary OA with imaging
Applicable To
- Degenerative joint disease of the right shoulder
Excludes
- Post-traumatic osteoarthritis (M19.111)
Clinical Validation Requirements
- X-ray showing joint space narrowing and osteophyte formation
Code-Specific Risks
- Risk of using unspecified codes if laterality is not documented.
Coding Notes
- Ensure laterality is documented to avoid unspecified codes.
M19.012 - Primary osteoarthritis, left shoulder
Use when primary OA is confirmed in the left shoulder without prior trauma.
Applicable To
- Degenerative joint disease of the left shoulder
Excludes
- Post-traumatic osteoarthritis (M19.112)
Clinical Validation Requirements
- X-ray showing joint space narrowing and osteophyte formation
Coding Notes
Ensure laterality is documented to avoid unspecified codes.
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 Osteoarthritis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M19.011.
Impact
Clinical: Inaccurate diagnosis and treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Ensure imaging results are included in the patient's record.
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Poor data quality affecting clinical decision-making.
Mitigation Strategy
Always document and code the specific side affected (right or left).
Impact
Using unspecified codes when specific codes are applicable.
Mitigation Strategy
Always document laterality and type of OA.
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 Osteoarthritis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Shoulder Osteoarthritis
Use these documentation templates to ensure complete and accurate documentation for Shoulder Osteoarthritis. 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
- Diagnosis
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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