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.

ICD-10 Coding for Shoulder Replacement(M19.011, M19.01, M19.0)

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Explore detailed coding guidelines and documentation requirements for shoulder replacement, including ICD-10 and CPT codes, clinical validation, and common pitfalls.

Also known as:

Shoulder ArthroplastyTotal Shoulder ReplacementReverse Shoulder Arthroplasty

Related ICD-10 Code Ranges

Complete code families applicable to Shoulder Replacement

M00-M99Primary Range

Diseases of the musculoskeletal system and connective tissue

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Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

Code	Description	When to Use	Key Documentation
M19.011	Primary osteoarthritis, right shoulder	Use when primary osteoarthritis is the reason for shoulder replacement.	Radiographic evidence of joint space narrowing Failed conservative treatment
M75.121	Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic	Use when shoulder replacement is due to rotator cuff tear arthropathy.	MRI confirmation of rotator cuff tear Clinical examination showing limited ROM

Primary ICD-10-CM Codes

Primary osteoarthritis, right shoulder

M19.011Billable

Differential Codes

Alternative codes to consider when ruling out similar conditions

Post-traumatic osteoarthritis, right shoulderM19.111

Use when osteoarthritis is due to previous shoulder trauma.

Traumatic rupture of right rotator cuffS46.011A

Use for acute traumatic injuries.

Documentation & Coding Risks

Avoid these common issues when documenting Shoulder Replacement.

Missing documentation of failed conservative treatment

Impact

Clinical: Inadequate justification for surgery, Regulatory: Potential audit failure, Financial: Denial of claims

Mitigation

Document all conservative measures tried, Include duration and outcomes of treatments

Incorrect laterality coding

Impact

Reimbursement: Claims may be denied or delayed., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.

Mitigation

Always verify and document the correct shoulder side (right or left).

Medical Necessity Documentation

Impact

Lack of detailed documentation supporting the necessity of shoulder replacement.

Mitigation

Ensure comprehensive documentation of clinical indications and failed treatments.

Frequently Asked Questions

Documentation requirements, coding pitfalls and FAQs for conditions coded with M19.011.

Primary Code

M19.011

Primary osteoarthritis, right shoulder

Quick Navigation

ICD-10 codes9

Coding risks3

FAQs2

ICD-10 Coding for Shoulder Replacement(M19.011, M19.01, M19.0)

Documentation & Coding Risks

Frequently Asked Questions

What is the ICD-10 code for shoulder replacement?

How do you code a reverse shoulder arthroplasty?

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