ICD Code M65.111

ICD code M65.111 is used to identify a medical condition known as "Other infective (teno)synovitis, right shoulder." This code is part of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), which is a system used by healthcare providers to classify and code all diagnoses, symptoms, and procedures. In this specific case, the code M65.111 refers to an infection that affects the synovial sheath, which is the protective covering around a tendon, in the right shoulder. This condition can cause pain, swelling, and reduced mobility in the affected area. The term "other infective" indicates that the infection is not caused by the most common pathogens typically associated with tenosynovitis, suggesting a need for further investigation to identify the specific infectious agent. Proper coding of this condition is crucial for accurate medical records, billing, and treatment planning.

When determining the appropriate use of the ICD code M65111, consider the following diagnostic criteria and symptoms:

1. Presence of Symptoms:
- Pain in the right shoulder
- Swelling or inflammation around the shoulder joint
- Limited range of motion in the right shoulder

2. Clinical Examination Findings:
- Tenderness upon palpation of the right shoulder
- Signs of warmth or redness over the affected area
- Crepitus or abnormal sounds during shoulder movement

3. Diagnostic Imaging:
- MRI or ultrasound showing fluid accumulation in the shoulder joint or surrounding tendons
- X-rays ruling out fractures or other bony abnormalities

4. Laboratory Tests:
- Elevated inflammatory markers (e.g., ESR, CRP)
- Positive cultures or serological tests indicating infection

5. Duration of Symptoms:
- Symptoms persisting for a specific duration (e.g., more than two weeks) without improvement

6. Response to Initial Treatment:
- Lack of improvement with conservative management (e.g., rest, ice, NSAIDs)

7. Exclusion of Other Conditions:
- Ruling out other potential causes of shoulder pain, such as rotator cuff injuries or arthritis

8. Patient History:
- Recent history of infection or trauma to the shoulder area
- Relevant medical history that may predispose the patient to infections (e.g., diabetes, immunocompromised status)

By adhering to these criteria, healthcare providers can accurately determine when to apply the ICD code M65111 in their documentation and billing processes.

For the ICD code M65.111, which pertains to other infective (teno)synovitis 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. 26055 - Incision with drainage of tendon sheath of hand and/or wrist (e.g., for abscess or tenosynovitis).

4. 26160 - Excision of lesion of tendon sheath or joint capsule (e.g., cyst, mucous cyst, or ganglion), hand or finger.

5. 29805 - Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure).

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

These CPT codes are examples of procedures that may be performed to address conditions associated with the ICD code M65.111. It is important for healthcare providers to select the appropriate CPT code based on the specific treatment rendered and the clinical scenario.

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