ICD Code M65.019

ICD code M65.019 is used to identify a medical condition characterized by an abscess of the tendon sheath in an unspecified shoulder. This code is part of the International Classification of Diseases, 10th Revision (ICD-10), which is used by healthcare providers to document and code diagnoses and procedures. An abscess of the tendon sheath involves a collection of pus that forms within the protective covering of a tendon, leading to inflammation and potential pain or restricted movement in the affected shoulder. The term "unspecified shoulder" indicates that the documentation does not specify whether the condition affects the left or right shoulder. Proper coding of such conditions is crucial for accurate medical records, billing, and insurance claims processing.

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

1. Presence of a palpable mass: A noticeable swelling or lump in the shoulder area that may indicate an abscess.

2. Localized pain: Patient reports pain in the shoulder region, particularly around the tendon sheath.

3. Limited range of motion: Difficulty or discomfort when moving the shoulder, which may be due to the presence of the abscess.

4. Swelling and inflammation: Observable redness, warmth, or swelling in the area surrounding the tendon sheath.

5. Fever or systemic symptoms: Patient may exhibit signs of infection, such as fever, chills, or malaise.

6. History of trauma or injury: Previous injury to the shoulder that may have led to the development of the abscess.

7. Drainage or discharge: Presence of pus or other fluid drainage from the area, indicating an infection.

8. Imaging findings: Confirmation of an abscess through ultrasound, MRI, or other imaging modalities showing fluid collection around the tendon sheath.

9. Response to conservative treatment: Lack of improvement with initial conservative management, such as rest, ice, or anti-inflammatory medications.

10. Underlying conditions: Consideration of any comorbidities that may predispose the patient to abscess formation, such as diabetes or immunosuppression.

These criteria should be evaluated in conjunction with clinical judgment to determine the appropriate use of the ICD code.

For the ICD code M65.019, which pertains to an abscess of the tendon sheath in an unspecified 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. 26020 - Drainage of tendon sheath, hand or finger

4. 26025 - Incision, extensor tendon sheath, wrist

5. 26030 - Incision, flexor tendon sheath, palm, or finger (eg, for trigger finger)

6. 26160 - Excision of lesion of tendon sheath or joint capsule (eg, cyst, mucous cyst, or ganglion), hand or finger

These CPT codes are examples of procedures that might be performed to address issues related to an abscess of the tendon sheath in the shoulder area. It is important to consult with a healthcare professional to determine the most appropriate procedure based on the specific clinical scenario.

Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments for CPT codes associated with ICD code M65019. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.