ICD 10 Coding Alert

Head to M75.12- when documentation doesn't specify 'traumatic.'

Before reporting ICD-10 codes from the M 75.12- range, you'll need to answer three questions about the patient's rotator cuff tear: Is the tear complete? Which shoulder is involved? Was trauma the cause?

The diagnosis: The rotator cuff is made of tendons and muscles in the shoulder that connect the arm bone to the shoulder blade and also help hold the arm bone in the shoulder socket. The codes below refer to a complete rupture, not just a partial tear through the tendons.

ICD-9-CM Code

• 727.61, Complete rupture of rotator cuff

ICD-10-CM Codes

• M75.120, Complete rotator cuff tear or rupture of unspecified shoulder, not specified as traumatic
• M75.121, Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic
• M75.122, Complete rotator cuff tear or rupture of left shoulder, not specified as traumatic

ICD-9 coding rules: Code 727.61 is specific to nontraumatic tears. If the patient has a partial, rather than a complete, tear you should use a different code (726.13, Partial tear of rotator cuff).

ICD-10 changes: ICD-10 has similar coding rules to ICD-9 for this diagnosis. The M75.12- code definitions indicate the codes are appropriate for tears or ruptures "not specified as traumatic." If the documentation doesn't specify complete, you should look to other code ranges: M75.10- (Unspecified rotator cuff tear or rupture, not specified as traumatic) or M75.11- (Incomplete rotator cuff tear or rupture not specified as traumatic).

Documentation: As you prepare for the transition to ICD-10, simplify the steps to gather the information you'll need to choose the proper code, including whether the tear is complete, which shoulder is affected, and whether trauma caused the condition.

Coder tips: The ICD-10 code definitions state "not specified as traumatic." That means these codes are appropriate if the documentation specifies the condition was not caused by trauma. The codes are also appropriate if the documentation doesn't specify either a traumatic or nontraumatic cause.