ICD-10 Coding for Torn Rotator Cuff(M75.121, S46.011A)
Complete ICD-10-CM coding and documentation guide for Torn Rotator Cuff. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Torn Rotator Cuff
M75.1-M75.12Primary Range
Non-traumatic rotator cuff tear or rupture
This range covers non-traumatic tears of the rotator cuff, which are common in degenerative conditions.
Traumatic rupture of rotator cuff
This range is used for coding traumatic tears of the rotator cuff, typically resulting from acute 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 |
|---|---|---|---|
| M75.121 | Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic | Use when documentation indicates a non-traumatic complete tear of the right shoulder. |
|
| S46.011A | Traumatic rupture of right rotator cuff | Use when the tear is directly linked to a traumatic event. |
|
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 torn rotator cuff
Essential facts and insights about Torn Rotator Cuff
Primary ICD-10-CM Codes for torn rotator cuff
Decision Criteria
clinical Criteria
- MRI confirms full-thickness tear without trauma
documentation Criteria
- Documentation specifies non-traumatic etiology
Applicable To
- Complete tear of supraspinatus tendon
Excludes
- Traumatic rupture of rotator cuff (S46.01-)
Clinical Validation Requirements
- MRI showing full-thickness tear
- Absence of trauma history
Code-Specific Risks
- Misclassification as traumatic without clear documentation
Coding Notes
- Ensure documentation specifies the non-traumatic nature and laterality of the tear.
S46.011A - Traumatic rupture of right rotator cuff
Use when the tear is directly linked to a traumatic event.
Applicable To
- Acute tear due to trauma
Excludes
- Non-traumatic rotator cuff tear (M75.1-)
Clinical Validation Requirements
- History of recent trauma or injury
- Clinical notes indicating acute onset
Coding Notes
Ensure trauma is clearly documented in the patient's history.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Bursitis of shoulder
M75.51Differential 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 Torn Rotator Cuff to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M75.121.
Impact
Clinical: Misleading clinical picture, Regulatory: Potential for audit issues, Financial: Incorrect reimbursement
Mitigation Strategy
Always include etiology in notes, Use templates to ensure completeness
Impact
Reimbursement: May lead to lower reimbursement rates, Compliance: Increases risk of audit failure, Data Quality: Reduces accuracy of clinical data
Mitigation Strategy
Always verify MRI and clinical documentation to use the most specific code.
Impact
Incorrect coding of shoulder side
Mitigation Strategy
Double-check documentation and imaging before coding.
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 Torn Rotator Cuff, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Torn Rotator Cuff
Use these documentation templates to ensure complete and accurate documentation for Torn Rotator Cuff. These templates include all required elements for proper coding and billing.
Arthroscopic rotator cuff repair
Specialty: OrthopedicsRequired Elements
- Procedure description
- Findings
- Technique
- Intraoperative photos
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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