ICD-10 Coding for Tendinitis Right Shoulder(M75.51, M75.111)
Complete ICD-10-CM coding and documentation guide for Tendinitis Right Shoulder. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Tendinitis Right Shoulder
M75.1-M75.8Primary Range
Shoulder lesions including tendinitis
This range includes specific codes for tendinitis of the shoulder, differentiating between bicipital and rotator cuff tendinitis.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M75.51 | Bicipital tendinitis, right shoulder | Use when the patient presents with pain localized to the bicipital groove and positive Speed’s or Yergason’s test. |
|
| M75.111 | Rotator cuff syndrome, right shoulder | Use when the patient presents with symptoms and imaging consistent with rotator cuff involvement. |
|
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 tendinitis right shoulder
Essential facts and insights about Tendinitis Right Shoulder
Primary ICD-10-CM Codes for tendinitis right shoulder
Decision Criteria
clinical Criteria
- Presence of tenderness over bicipital groove and positive Speed’s test
Applicable To
- Long head of biceps tendinitis
Excludes
- Calcific tendinitis (M75.3)
Clinical Validation Requirements
- Ultrasound showing biceps tendon inflammation
- Clinical correlation with positive Speed’s or Yergason’s test
Code-Specific Risks
- Confusing with general shoulder pain codes
Coding Notes
- Ensure documentation specifies 'bicipital' or 'long head of biceps' to justify use.
M75.111 - Rotator cuff syndrome, right shoulder
Use when the patient presents with symptoms and imaging consistent with rotator cuff involvement.
Applicable To
- Supraspinatus tendinitis
- Infraspinatus tendinitis
Excludes
- Bicipital tendinitis (M75.51)
Clinical Validation Requirements
- MRI showing increased T2 signal in rotator cuff tendons
- Positive Hawkins or Neer’s test
Coding Notes
Ensure documentation includes specific rotator cuff tests and imaging findings.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Pain in right shoulder
M25.511Differential 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 Tendinitis Right Shoulder to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M75.51.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims or reduced reimbursement.
Mitigation Strategy
Train providers to document specific tendon involvement., Use templates that prompt for detailed exam findings.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Inaccurate coding can lead to compliance issues., Data Quality: Reduces specificity and accuracy of clinical data.
Mitigation Strategy
Require documentation of specific tendon involvement to use M75.51 or M75.111.
Impact
Auditors may flag cases where general pain codes are used instead of specific tendinitis codes.
Mitigation Strategy
Ensure documentation supports the specific tendinitis code used.
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 Tendinitis Right Shoulder, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Tendinitis Right Shoulder
Use these documentation templates to ensure complete and accurate documentation for Tendinitis Right Shoulder. These templates include all required elements for proper coding and billing.
Orthopedic Evaluation for Shoulder Pain
Specialty: OrthopedicsRequired 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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