ICD-10 Coding for Thoracic Outlet Syndrome(G54.0, I87.1, I77.0)
Complete ICD-10-CM coding and documentation guide for Thoracic Outlet Syndrome. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Thoracic Outlet Syndrome
G54-G55Primary Range
Nerve root and plexus disorders
Includes neurogenic thoracic outlet syndrome, which involves brachial plexus compression.
Other disorders of arteries and arterioles
Includes arterial thoracic outlet syndrome, involving subclavian artery compression.
Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified
Includes venous thoracic outlet syndrome, particularly with subclavian vein compression.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| G54.0 | Brachial plexus disorders | Use when neurogenic symptoms are confirmed by clinical tests and imaging. |
|
| I87.1 | Compression of vein | Use when venous symptoms are confirmed by imaging. |
|
| I77.0 | Arterial compression syndrome | Use when arterial symptoms are confirmed by imaging. |
|
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 thoracic outlet syndrome
Essential facts and insights about Thoracic Outlet Syndrome
Primary ICD-10-CM Codes for thoracic outlet syndrome
Decision Criteria
clinical Criteria
- Presence of brachial plexus compression symptoms
Applicable To
- Neurogenic thoracic outlet syndrome
Excludes
- Venous thoracic outlet syndrome
- Arterial thoracic outlet syndrome
Clinical Validation Requirements
- Brachial plexus compression
- Positive Roos test
Code-Specific Risks
- Misclassification if venous or arterial involvement is present.
Coding Notes
- Ensure documentation specifies neurogenic involvement.
I87.1 - Compression of vein
Use when venous symptoms are confirmed by imaging.
Applicable To
- Venous thoracic outlet syndrome
Excludes
- Neurogenic thoracic outlet syndrome
- Arterial thoracic outlet syndrome
Clinical Validation Requirements
- Subclavian vein obstruction
- Venography confirmation
Coding Notes
Document venous compression and any thrombosis.
I77.0 - Arterial compression syndrome
Use when arterial symptoms are confirmed by imaging.
Applicable To
- Arterial thoracic outlet syndrome
Excludes
- Neurogenic thoracic outlet syndrome
- Venous thoracic outlet syndrome
Clinical Validation Requirements
- Subclavian artery compression
- CT angiography confirmation
Coding Notes
Ensure documentation specifies arterial involvement.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Cervical rib
Q76.5Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Thoracic Outlet Syndrome to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code G54.0.
Impact
Clinical: Inaccurate treatment planning, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials
Mitigation Strategy
Educate providers on documentation requirements, Implement EHR prompts for TOS type
Impact
Reimbursement: Incorrect DRG assignment leading to reimbursement issues., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use I87.1 for venous TOS and add I82.891 if DVT is present.
Impact
Using incorrect codes for TOS types can lead to audits.
Mitigation Strategy
Ensure thorough documentation and correct code selection.
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 Thoracic Outlet Syndrome, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Thoracic Outlet Syndrome
Use these documentation templates to ensure complete and accurate documentation for Thoracic Outlet Syndrome. These templates include all required elements for proper coding and billing.
Neurogenic TOS Diagnosis
Specialty: NeurologyRequired Elements
- Patient history
- Physical exam findings
- Imaging results
- Test results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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