ICD Code M62.011

ICD code M62.011 is used to identify a condition characterized by the separation of muscle in the right shoulder that is not caused by trauma. This code is part of the International Classification of Diseases (ICD) system, which is used by healthcare providers to classify and code all diagnoses, symptoms, and procedures. The "M62" category refers to disorders of muscle, and the specific code "011" indicates the nontraumatic separation of muscle tissue in the right shoulder. This condition may result from overuse, strain, or other non-injury-related factors, and accurate coding is essential for proper documentation, treatment planning, and billing processes within the healthcare revenue cycle.

When to use the ICD code for separation of muscle (nontraumatic), right shoulder:

1. Clinical Diagnosis: A healthcare provider has made a clinical diagnosis of a nontraumatic separation of muscle in the right shoulder.

2. Patient Symptoms:

- Pain in the right shoulder region.

- Swelling or inflammation around the shoulder area.

- Limited range of motion in the right shoulder.

- Muscle weakness in the right shoulder.

- Tenderness upon palpation of the affected area.

3. Medical History: The patient has a relevant medical history that may contribute to the condition, such as:

- Previous shoulder injuries or surgeries.

- Chronic conditions affecting muscle integrity or strength.

4. Diagnostic Imaging: Imaging studies (e.g., MRI, ultrasound) indicate muscle separation or related abnormalities in the right shoulder.

5. Exclusion of Traumatic Causes: The absence of any recent trauma or injury that could account for the muscle separation.

6. Duration of Symptoms: Symptoms have persisted for a specific duration, indicating a nonacute condition, typically longer than a few days.

7. Response to Treatment: The patient has not responded to conservative treatment measures, such as rest, ice, or physical therapy, indicating the need for further evaluation and coding.

8. Documentation: Comprehensive documentation in the medical record supports the diagnosis, including clinical findings, patient-reported symptoms, and any relevant test results.

These criteria help ensure accurate coding and appropriate reimbursement for the services provided.

For the ICD code M62.011, which pertains to the separation of muscle (nontraumatic) in the right shoulder, the relevant CPT codes that may be applicable for treatment include:

1. 23410 - Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; acute.

2. 23412 - Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; chronic.

3. 23420 - Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty).

4. 29827 - Arthroscopy, shoulder, surgical; with rotator cuff repair.

5. 24341 - Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary (excludes rotator cuff).

These CPT codes are typically used for surgical interventions related to muscle separation or repair in the shoulder area. It is important for healthcare providers to select the appropriate CPT code based on the specific procedure performed and the clinical scenario. Proper coding ensures accurate billing and reimbursement in the healthcare revenue cycle management process.

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