ICD Code M65.011

ICD code M65.011 is used to identify a medical condition characterized by an abscess of the tendon sheath located in the right shoulder. An abscess in this context refers to a collection of pus that has accumulated within the tendon sheath, which is the protective covering surrounding a tendon. This condition can lead to pain, swelling, and restricted movement in the affected shoulder, and it often requires medical intervention to treat the infection and alleviate symptoms. Proper coding of this condition is crucial for accurate medical documentation, billing, and treatment planning.

When to use the ICD code for an abscess of the tendon sheath in the right shoulder, consider the following diagnostic criteria and symptoms:

1. Presence of Localized Swelling: Noticeable swelling in the right shoulder area, particularly around the tendon sheath.

2. Pain and Tenderness: Patient reports pain and tenderness in the right shoulder, especially when moving the arm or applying pressure to the affected area.

3. Limited Range of Motion: Difficulty or discomfort when attempting to move the shoulder joint, indicating potential involvement of the tendon sheath.

4. Fever or Systemic Symptoms: Patient may exhibit fever or other systemic symptoms, suggesting an infectious process.

5. Redness and Warmth: Observation of redness and warmth over the affected area, indicating inflammation.

6. Pus or Drainage: Presence of pus or drainage from the area, which may be noted during physical examination.

7. History of Trauma or Overuse: Patient may have a history of trauma, repetitive use, or underlying conditions that predispose them to tendon sheath issues.

8. Imaging Findings: Diagnostic imaging (e.g., ultrasound or MRI) may reveal fluid accumulation or abscess formation around the tendon sheath.

9. Response to Treatment: Lack of improvement with conservative treatment measures, such as rest, ice, or anti-inflammatory medications, may warrant further investigation and coding.

10. Differential Diagnosis: Exclusion of other potential causes of shoulder pain and swelling, such as bursitis or tendonitis, to confirm the diagnosis of an abscess.

These criteria should be carefully evaluated to determine the appropriate use of the ICD code in clinical documentation and billing processes.

For the ICD code M65.011, which refers to an abscess of the tendon sheath in the right shoulder, the relevant CPT codes that may be applicable for treatment include:

1. 26010 - Drainage of finger abscess; simple.

2. 26011 - Drainage of finger abscess; complicated (eg, felon).

3. 23930 - Incision and drainage, upper arm or elbow area; deep abscess or hematoma.

4. 23931 - Incision and drainage, shoulder area; deep abscess or hematoma.

These CPT codes are typically used for procedures involving the drainage or surgical intervention of abscesses in the specified areas. It's important for healthcare providers to select the appropriate CPT code based on the specific procedure performed and the complexity of the case. Always ensure that the documentation supports the chosen CPT code to facilitate accurate billing and reimbursement.

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