Orthopedic Coding Alert

Find out how 726.xx expands into numerous options with different lingo.

Shoulder lesions mean that the patient presents with diseased or damaged tissue in the shoulder. To report the correct code, you should specify which shoulder the lesion is occurring in and the type of lesion it is.

ICD-9-CM Codes: Currently, you would reflect shoulder lesions with the following codes:

• 726.0, Adhesive capsulitis of shoulder
  
• 726.10, Disorders of bursae and tendons in shoulder region unspecified
  
• 726.11, Calcifying tendinitis of shoulder
  
• 726.12, Bicipital tenosynovitis
  
• 726.19, Other specified disorders of bursae and tendons in shoulder region
  
• 726.2, Other affections of shoulder region not elsewhere classified.
  

ICD-10-CM Codes: Here are your new ICD-10 options:

• M75.00, Adhesive capsulitis of unspecified shoulder
  
• M75.01, Adhesive capsulitis of right shoulder
  
• M75.02, Adhesive capsulitis of left shoulder
  
• M75.10,  Unspecified rotator cuff tear or rupture, not specified as traumatic
  
• M75.11,  Incomplete rotator cuff tear or rupture not specified as traumatic
  
• M75.12,  Complete rotator cuff tear or rupture not specified as traumatic
  
• M75.20, Bicipital tendinitis, unspecified shoulder
  
• M75.21, Bicipital tendinitis, right shoulder
  
• M75.22, Bicipital tendinitis, left shoulder
  
• M75.30, Calcific tendinitis of unspecified shoulder
  
• M75.31, Calcific tendinitis of right shoulder
  
• M75.32, Calcific tendinitis of left shoulder
  
• M75.40, Impingement syndrome of unspecified shoulder
  
• M75.41, Impingement syndrome of right shoulder
  
• M75.42, Impingement syndrome of left shoulder
  
• M75.50, Bursitis of unspecified shoulder
  
• M75.51, Bursitis of right shoulder
  
• M75.52, Bursitis of left shoulder
  
• M75.80, Other shoulder lesions, unspecified shoulder
  
• M75.81, Other shoulder lesions, right shoulder
  
• M75.82, Other shoulder lesions, left shoulder
  
• M75.90, Shoulder lesions, unspecified, unspecified shoulder
  
• M75.91, Shoulder lesions, unspecified, right shoulder
  
• M75.92, Shoulder lesions, unspecified, left shoulder.
  

ICD-10-CM Change: When ICD-10 hits, you will need to report the shoulder lesion code based on the shoulder in which it is occurring. You do have a code for unspecified, but you should always code to the highest specificity. 

Code 726.10 expands into M75.10, M75.11, M75.12, M75.50, M75.51, and M75.52. 

Code 726.2 expands into M75.40, M75.41, M75.42, M75.80, M75.81, M75.82, M75.90, M75.91, and M75.92. 

Documentation: The provider probably already specifies right or left, but now you have new codes to reflect that.

If your physician documents “frozen shoulder” or “adhesive capsulitis,” you should chose a code from the M75.0- category. 

If your physician documents “rotator cuff” or “supraspinatus tear or rupture (complete) (incomplete), not specified as traumatic Supraspinatus syndrome,” you should chose a code from the M75.1- category.

Here is how you will locate this code in your Alphabetic Index:

Bursitis M71.9

- Duplay’s M75.0
- shoulder M75.5-
- - adhesive —see Capsulitis, adhesive

Calcification

- bursa M71.40
- - shoulder M75.3-
Capsulitis (joint) —see also Enthesopathy
- adhesive (shoulder) M75.0-
Lesion(s) (nontraumatic)
- shoulder (region) M75.9-
- - specified NEC M75.8-
Periarthritis (joint) —see also Enthesopathy
- Duplay’s M75.0-

Rupture, ruptured

- rotator cuff (complete) (incomplete) (nontraumatic) M75.1-
- supraspinatus (complete) (incomplete) (nontraumatic) M75.1-

Syndrome —see also Disease

- impingement, shoulder M75.4-
- rotator cuff, shoulder M75.1-
- supraspinatus M75.1-

Tear, torn (traumatic) —see also Laceration

- rotator cuff (complete) (incomplete) (nontraumatic) M75.1-
- - traumatic S46.01-
- - - capsule S43.42-
- supraspinatus (complete) (incomplete) (nontraumatic) M75.1-

Tendinitis, tendonitis —see also Enthesopathy

- bicipital M75.2-
- calcific M65.2-
- - shoulder M75.3-

Coding tips: You will see an Excludes 2 for all of the codes in this category, which means that you can report “shoulder-hand syndrome (M89.0-)” with these codes, but your physician must document both conditions.