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Home/Diagnosis/ICD-10 Coding for Shoulder Replacement

ICD-10 Coding for Shoulder Replacement

M19.011
M75.121

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

Also Known as:
Shoulder Arthroplasty
Total Shoulder Replacement
Reverse Shoulder Arthroplasty
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Key Information: ICD-10 Coding for Shoulder Replacement

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

Use ICD-10 code M19.011 for primary osteoarthritis, right shoulder, ensuring proper documentation in clinical notes.

Primary ICD-10-CM Codes

Primary osteoarthritis, right shoulder

Billable Code
M19.011
Billable

Diagnostic Criteria

clinical:
  • • Radiographic evidence of joint degeneration
documentation:
  • • Detailed history of failed conservative treatments

Applicable To

  • • Osteoarthritis of right shoulder

Important Notes

  • • Ensure documentation supports primary osteoarthritis as the indication for surgery.

Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic

Billable Code
M75.121
Billable

Diagnostic Criteria

clinical:
  • • MRI confirmation of rotator cuff tear
  • • Clinical examination showing limited ROM

Applicable To

  • • Rotator cuff tear arthropathy

Important Notes

  • • Document the chronic nature of the tear and its impact on shoulder function.
Frequently Asked Questions

What is the ICD-10 code for shoulder replacement?

The ICD-10 code for shoulder replacement due to primary osteoarthritis is M19.011 for the right shoulder and M19.012 for the left shoulder.

How do you code a reverse shoulder arthroplasty?

Use CPT code 23472 for reverse shoulder arthroplasty, adding modifier 22 for complex cases.

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