ICD-10 Coding for Rotator Cuff Repair(M75.111, M75.111B, M75.111I)
Learn about the ICD-10 coding and documentation requirements for rotator cuff repairs, including traumatic and chronic tears. Ensure accurate billing and compliance.
Complete code families applicable to Rotator Cuff Repair
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S46.011A | Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial encounter | Use for acute traumatic tears of the right rotator cuff. |
|
| M75.111 | Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic | Use for chronic degenerative tears of the right rotator cuff. |
|
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
Essential facts and insights aboutRotator Cuff Repair
Alternative codes to consider when ruling out similar conditions
Use when the tear is degenerative rather than traumatic.
Use when the tear is due to a specific traumatic event.
Documentation & Coding Risks
Avoid these common issues when documenting Rotator Cuff Repair.
Not specifying acute or chronic for open repairs
Impact
Clinical: Inaccurate clinical records, Regulatory: Potential for audit discrepancies, Financial: Denied claims or incorrect reimbursement
Mitigation
Use templates that prompt for tear chronicity, Educate staff on documentation requirements
Assuming chronicity based on symptom duration
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: May result in audits if documentation does not support the code., Data Quality: Affects the accuracy of clinical data and patient records.
Mitigation
Base chronicity on the presence of trauma, not time since injury.
Laterality
Impact
Missing laterality in documentation can lead to claim denials.
Mitigation
Implement mandatory fields for laterality in EHR templates.
Frequently Asked Questions
Primary Code
Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial encounter