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Home/Diagnosis/ICD-10 Coding for Shoulder Injury

ICD-10 Coding for Shoulder Injury

S46.011A
S42.255A

Complete ICD-10-CM coding and documentation guide for icd-10 coding for shoulder injury includes clinical validation requirements, medical necessity guidelines, and coding policies.

Also Known as:
Shoulder Pain
Rotator Cuff Tear
Shoulder Sprain
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Key Information: ICD-10 Coding for Shoulder Injury

Essential facts and insights about ICD-10 Coding for Shoulder Injury

Use ICD-10 code S46.011A for strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial encounter, ensuring proper documentation in clinical notes.

Primary ICD-10-CM Codes

Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial encounter

Billable Code
S46.011A
Billable

Diagnostic Criteria

clinical:
  • • MRI shows full-thickness tear
documentation:
  • • Document acute onset and mechanism of injury

Applicable To

  • • Acute rotator cuff tear

Important Notes

  • • Ensure documentation specifies acute trauma and MRI findings.

Displaced fracture of surgical neck of left humerus, initial encounter

Billable Code
S42.255A
Billable

Diagnostic Criteria

clinical:
  • • X-ray confirmation of displacement
documentation:
  • • Mechanism of injury documented

Applicable To

  • • Displaced surgical neck fracture

Important Notes

  • • Ensure encounter type and fracture specifics are documented.
Ancillary Codes

Additional codes that may be used with this diagnosis

M25.511

Pain in right shoulder

Use to document associated pain symptoms.

M25.612

Stiffness of left shoulder

Use to document associated stiffness.

Frequently Asked Questions

What is the ICD-10 code for a shoulder injury?

The ICD-10 code for a shoulder injury varies based on the specific condition, such as S46.011A for an acute rotator cuff tear or S42.255A for a displaced fracture.

How do you code a rotator cuff tear?

For an acute rotator cuff tear, use S46.011A if it is the initial encounter. Ensure MRI confirmation and document the mechanism of injury.

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