ICD-10 Coding for Shoulder Replacement(M19.011, M75.121)
Complete ICD-10-CM coding and documentation guide for Shoulder Replacement. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Shoulder Replacement
M19.01-M19.93Primary Range
Primary osteoarthritis of shoulder
This range includes codes for osteoarthritis, which is a common indication for shoulder replacement.
Rotator cuff syndrome
These codes are used when shoulder replacement is performed due to rotator cuff tear arthropathy.
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 osteoarthritis is the reason for shoulder replacement. |
|
| M75.121 | Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic | Use when shoulder replacement is due to rotator cuff tear arthropathy. |
|
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 replacement
Essential facts and insights about Shoulder Replacement
Primary ICD-10-CM Codes for shoulder replacement
Decision Criteria
clinical Criteria
- Radiographic evidence of joint degeneration
documentation Criteria
- Detailed history of failed conservative treatments
Applicable To
- Osteoarthritis of right shoulder
Excludes
- Post-traumatic osteoarthritis (M19.111)
Clinical Validation Requirements
- Radiographic evidence of joint space narrowing
- Failed conservative treatment
Code-Specific Risks
- Ensure laterality is documented
- Verify osteoarthritis is primary, not post-traumatic
Coding Notes
- Ensure documentation supports primary osteoarthritis as the indication for surgery.
M75.121 - Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic
Use when shoulder replacement is due to rotator cuff tear arthropathy.
Applicable To
- Rotator cuff tear arthropathy
Excludes
- Traumatic rotator cuff tear (S46.011A)
Clinical Validation Requirements
- MRI confirmation of rotator cuff tear
- Clinical examination showing limited ROM
Coding Notes
Document the chronic nature of the tear and its impact on shoulder function.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Shoulder Replacement to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M19.011.
Impact
Clinical: Inadequate justification for surgery, Regulatory: Potential audit failure, Financial: Denial of claims
Mitigation Strategy
Document all conservative measures tried, Include duration and outcomes of treatments
Impact
Reimbursement: Claims may be denied or delayed., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Always verify and document the correct shoulder side (right or left).
Impact
Lack of detailed documentation supporting the necessity of shoulder replacement.
Mitigation Strategy
Ensure comprehensive documentation of clinical indications and failed treatments.
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 Replacement, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Shoulder Replacement
Use these documentation templates to ensure complete and accurate documentation for Shoulder Replacement. These templates include all required elements for proper coding and billing.
Total Shoulder Arthroplasty
Specialty: Orthopedic SurgeryRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Operative details
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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