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Shoulder/Arm

Diagnosis

Procedure-CPT

ICD10-Right

ICD10-Left

Shoulder

Pain

Stiffness

Sprain

Effusion

Contusion

Artificial Joint

E/M Coding

 

Modifiers

M25.511 Pain in right shoulder

M25.611 Stiffness of right shoulder 

S43.491A Other sprain of right shoulder joint

M25.411 Effusion, right shoulder 

S40.011A Contusion of right shoulder, 

Z96.611 Presence of right artificial shoulder joint

M25.512 Pain in left shoulder

M25.612 Stiffness of left shoulder 

S43.492A Other sprain of left shoulder joint, 

M25.412 Effusion, left shoulder 

S40.012A Contusion of left shoulder, 

Z96.612 Presence of left artificial shoulder joint

Acromioclavicular Arthritis M19.019 715.11

Distal Clavicle Resection 29824

CPT Coding

M19.011 - Primary osteoarthritis, right

M19.012 - Primary osteoarthritis, left

Acromioclavicular Joint Separations S43.109A

Acromioclavicular Joint Reconstruction 23552 

CPT Coding

S43.101A - Unspecified

S43.121A -100%-200% displacement 

S43.131A -  greater than 200%

S43.102A - Unspecified

S43.122A -100%-200% displacement 

S43.132A -  greater than 200%

Acromion Fracture S42.123A

Acromion Fracture ORIF 23585

S42.121A - Displaced right

S42.122A - Displaced left

Adhesive Capsulitis M75.00

Arthroscopic Capsular Release 29825

CPT Coding

M75.01 Adhesive capsulitis right shoulder

M75.02 Adhesive capsulitis left shoulder

Biceps Tendonitis M75.20

Biceps Tenodesis 23430 29828

CPT Coding

M75.21 Bicipital tendinitis, right shoulder

M75.22 Bicipital tendinitis, left shoulder

Bursitis of Shoulder M75.50

Subacromial Decompression 29826

CPT Coding

M75.51 Bursitis right shoulder

M75.52 Bursitis left shoulder

Calcific Tendinitis of the RTC M75.30

 

M75.31 Calcific tendinitis right shoulder

M75.32 Calcific tendinitis left shoulder

Clavicle Fracture S42.023A 810.02

Clavicle Fracture ORIF 23515

CPT Coding

S42.021A Displaced fracture shaft right clavicle, initial closed

S42.025A Nondisplaced fracture shaft left clavicle, initial closed

Distal Clavicle Fracture S42.033A

Clavicle Fracture ORIF 23515 

CPT Coding

S42.031A Displaced fracture lateral end right clavicle, initial closed

S42.032A Displaced fracture lateral end left clavicle, initial closed

Distal Clavicle Osteolysis M89.519

Distal Clavicle Resection 29824 

CPT Coding

M89.511 Osteolysis, right shoulder

M89.512 Osteolysis, left shoulder

Glenohumeral Arthritis M19.019

Total Shoulder Arthroplasty 23472

CPT Coding

M19.011 Primary osteoarthritis, right shoulder

M19.012 - Primary osteoarthritis, left shoulder

Greater Tuberosity Fracture S42.253A

Greater Tuberosity Fracture ORIF 23630  

CPT codes

S42.251A - Displaced fracture of greater tuberosity of right humerus

S42.252A - Displaced fracture of greater tuberosity of left humerus

Humeral Shaft Fracture S42.399A

Humeral Shaft Fracture ORIF 24515

CPT Coding

S42.341A Displaced spiral fracture shaft humerus, right arm, initial closed

S42.342A Displaced spiral fracture shaft humerus, left arm, initial closed

Proximal Humerus Fracture S42.209A

Proximal Humerus Fracture ORIF 23615 

CPT Codes

S42.241A 4-part fracture surgical neck right humerus, initial closed 

S42.201A - Unspecified

42.242A 4-part fracture surgical neck left humerus, initial closed

 S42.202A - Unspecified

Rotator Cuff Strain S46.019A

 

S46.011A Strain muscle(s) and tendon(s) the rotator cuff right shoulder, initial

S46.012A Strain muscle(s) and tendon(s) the rotator cuff left shoulder, initial

Rotator Cuff Tear (RTC) M75.120

Rotator Cuff Repair 29827

CPT Coding

M75.121 Complete rotator cuff tear or rupture right shoulder, not specified as traumatic

M75.122 Complete rotator cuff tear or rupture left shoulder, not specified as traumatic

Rotator Cuff Partial Thickness Tear M75.110

Rotator Cuff Repair 29827

CPT Coding

M75.111 Incomplete rotator cuff tear or rupture right shoulder, not specified as traumatic

M75.112 Incomplete rotator cuff tear or rupture left shoulder, not specified as traumatic

Shoulder Arthritis M19.019

Total Shoulder Arthroplasty 23472

CPT Coding

M19.011 Primary osteoarthritis, right shoulder

M19.012 Primary osteoarthritis, left shoulder

Shoulder Dislocation S43.016A

 

S43.014A Anterior dislocation right humerus, initial

S43.015A Anterior dislocation left humerus, initial

Shoulder Pain

 

M25.511 Pain in right shoulder

M25.512 Pain in left shoulder

SLAP Tear S43.439A

SLAP Repair 29807

CPT Coding

S43.431A

S43.432A

Stiffness in Shoulder

 

M25.611

M25.612

Subacromial Impingement M75.50 726.10

Subacromial Decompression 29826

CPT Coding

M75.41 Impingement syndrome right shoulder

M75.42 Impingement syndrome left shoulder

 

 

see 7th Character Coding

A=initial encounter, D=subsequent encounter, S=sequela