ICD-10 Coding for SLAP Tear(S43.431A, M75.81)
Complete ICD-10-CM coding and documentation guide for SLAP Tear. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to SLAP Tear
S43.431-S43.439Primary Range
Dislocation and sprain of joints and ligaments of shoulder girdle
This range includes codes for traumatic SLAP tears, which are common in acute injuries.
Other shoulder lesions
This range is relevant for chronic or degenerative SLAP tears without recent trauma.
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 initial encounters of acute traumatic SLAP tears. |
|
| M75.81 | Other shoulder lesions, right shoulder | Use for chronic or degenerative SLAP tears without recent 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 SLAP tear
Essential facts and insights about SLAP Tear
Primary ICD-10-CM Codes for slap tear
Decision Criteria
clinical Criteria
- MRI shows contrast extravasation into superior labrum
documentation Criteria
- Operative note specifies SLAP lesion and repair details
Applicable To
- Acute traumatic SLAP tear
Excludes
- Degenerative SLAP tear (M75.81)
Clinical Validation Requirements
- MRI-confirmed superior labral tear between 10-2 o’clock positions
- Positive O'Brien's test
Code-Specific Risks
- Incorrectly using for degenerative tears
Coding Notes
- Ensure documentation specifies 'SLAP lesion' and the tear's clock position.
M75.81 - Other shoulder lesions, right shoulder
Use for chronic or degenerative SLAP tears without recent trauma.
Applicable To
- Chronic degenerative SLAP tear
Excludes
- Acute traumatic SLAP tear (S43.431A)
Clinical Validation Requirements
- MRI showing labral degeneration without acute trauma
- Progressive shoulder instability
Coding Notes
Ensure documentation specifies chronic nature and absence of recent trauma.
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 SLAP 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: Inaccurate diagnosis and treatment records., Regulatory: Potential for audit issues., Financial: Claim denials or reduced reimbursement.
Mitigation Strategy
Use detailed operative notes., Include imaging results in the patient's record.
Impact
Reimbursement: Incorrect billing may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use 29806 for inferior labrum repairs.
Impact
Improper use of modifiers when billing for multiple procedures.
Mitigation Strategy
Ensure documentation supports the use of modifiers.
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 SLAP Tear, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for SLAP Tear
Use these documentation templates to ensure complete and accurate documentation for SLAP Tear. These templates include all required elements for proper coding and billing.
Acute Traumatic SLAP Tear Repair
Specialty: Orthopedic SurgeryRequired Elements
- Mechanism of injury
- Physical exam findings
- MRI results
- Surgical details
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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