ICD Code M19.011

ICD code M19.011 is used to identify primary osteoarthritis in the right shoulder. This code is part of the International Classification of Diseases, 10th Revision (ICD-10), which is utilized by healthcare providers to document and categorize diagnoses. Primary osteoarthritis refers to the degenerative joint disease that occurs without any identifiable cause, leading to the breakdown of cartilage in the shoulder joint, resulting in pain and reduced mobility. The specificity of this code helps in accurate billing, treatment planning, and statistical analysis within the healthcare system.

1. Chronic Joint Pain: Persistent pain in the right shoulder that worsens with activity and improves with rest, indicating a degenerative condition rather than an acute injury.

2. Stiffness: Noticeable stiffness in the right shoulder, particularly in the morning or after periods of inactivity, which gradually improves with movement.

3. Limited Range of Motion: Difficulty in moving the right shoulder through its full range of motion, often accompanied by a grinding sensation or audible crepitus.

4. Swelling: Mild to moderate swelling around the right shoulder joint, which may fluctuate with activity levels.

5. Tenderness: Tenderness to touch around the right shoulder joint, particularly over the joint line or bony prominences.

6. X-ray Findings: Radiographic evidence of joint space narrowing, osteophyte formation, subchondral sclerosis, or cysts in the right shoulder, indicative of degenerative changes.

7. Age Factor: Typically observed in middle-aged or older adults, as primary osteoarthritis is more common with advancing age.

8. Exclusion of Other Conditions: Absence of inflammatory markers or systemic symptoms that would suggest rheumatoid arthritis or other inflammatory arthropathies.

9. History of Joint Use: A history of repetitive use or overuse of the right shoulder, which may contribute to the wear and tear of the joint.

10. No Significant Trauma: Lack of a recent significant traumatic event to the right shoulder that could explain the symptoms, distinguishing it from post-traumatic arthritis.

For the ICD code M19.011, which pertains to primary osteoarthritis of the right shoulder, the relevant CPT codes that may be applicable for treatment include:

1. 20610 - Arthrocentesis, aspiration, and/or injection into a major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa); without ultrasound guidance.

2. 20611 - Arthrocentesis, aspiration, and/or injection into a major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa); with ultrasound guidance, with permanent recording and reporting.

3. 23410 - Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; acute.

4. 23412 - Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; chronic.

5. 23420 - Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty).

6. 29806 - Arthroscopy, shoulder, surgical; capsulorrhaphy.

7. 29807 - Arthroscopy, shoulder, surgical; repair of SLAP lesion.

8. 29821 - Arthroscopy, shoulder, surgical; synovectomy, complete.

9. 29823 - Arthroscopy, shoulder, surgical; debridement, extensive.

10. 29824 - Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure).

11. 29826 - Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release.

These CPT codes are examples of procedures that may be performed to address conditions associated with primary osteoarthritis of the right shoulder, as indicated by ICD code M19.011. It's important for healthcare providers to select the appropriate CPT code based on the specific treatment and procedures performed.

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