ICD-10 Coding for Sprain of Right Shoulder(S43.401A, S43.41XA)
Complete ICD-10-CM coding and documentation guide for Sprain of Right Shoulder. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Sprain of Right Shoulder
S43.4-Primary Range
Sprains and strains of shoulder joint and ligaments
This range includes all sprains related to the shoulder joint, focusing on ligament injuries.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S43.401A | Unspecified sprain of right shoulder joint, initial encounter | Use when the specific ligament or joint involved is not documented. |
|
| S43.41XA | Sprain of acromioclavicular joint of right shoulder, initial encounter | Use when the sprain involves the acromioclavicular joint. |
|
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 right shoulder sprain
Essential facts and insights about Sprain of Right Shoulder
Primary ICD-10-CM Codes for sprain of right shoulder
Decision Criteria
clinical Criteria
- Presence of shoulder pain and tenderness without specific ligament identification.
Applicable To
- General sprain of right shoulder
Excludes
- Strain of right shoulder (S46.-)
Clinical Validation Requirements
- Physical exam showing tenderness and limited range of motion
- Absence of neurological symptoms
Code-Specific Risks
- Risk of denial if more specific codes are applicable.
Coding Notes
- Ensure documentation specifies the ligament involved if possible.
S43.41XA - Sprain of acromioclavicular joint of right shoulder, initial encounter
Use when the sprain involves the acromioclavicular joint.
Applicable To
- Sprain of right AC joint
Excludes
- Dislocation of right AC joint (S43.151A)
Clinical Validation Requirements
- Positive cross-body adduction test
- Tenderness over AC joint
Coding Notes
Document specific tests confirming AC joint involvement.
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 Sprain of Right Shoulder to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S43.401A.
Impact
Clinical: Inadequate clinical picture for treatment planning., Regulatory: Non-compliance with coding guidelines., Financial: Potential claim denials due to incomplete documentation.
Mitigation Strategy
Always include a detailed description of how the injury occurred.
Impact
Reimbursement: Potential claim denials or reduced reimbursement., Compliance: Non-compliance with coding specificity requirements., Data Quality: Decreased accuracy in clinical data reporting.
Mitigation Strategy
Use specific codes like S43.41XA when the AC joint is involved.
Impact
High risk of audit if unspecified codes are used when specific codes are applicable.
Mitigation Strategy
Ensure documentation supports the most specific code possible.
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 Sprain of Right Shoulder, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Sprain of Right Shoulder
Use these documentation templates to ensure complete and accurate documentation for Sprain of Right Shoulder. These templates include all required elements for proper coding and billing.
Initial Emergency Department Visit
Specialty: Emergency MedicineRequired Elements
- History of present illness
- Physical examination findings
- Imaging results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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