ICD Code M65.819

ICD code M65819 is used to identify a medical condition characterized by inflammation of the synovial membrane and tendon sheath in the shoulder, but without specifying which shoulder is affected. Synovitis refers to the inflammation of the synovial membrane, which lines joints and tendon sheaths, while tenosynovitis involves inflammation of the sheath surrounding a tendon. This code is typically used when the specific shoulder (left or right) is not documented in the patient's medical records. Proper coding of such conditions is crucial for accurate billing and reimbursement processes in healthcare revenue cycle management.

When to use the ICD code M65819 for Other synovitis and tenosynovitis, unspecified shoulder:

1. Presence of Synovitis
- Swelling and inflammation of the synovial membrane in the shoulder joint.

2. Symptoms of Tenosynovitis
- Pain and tenderness around the shoulder, particularly during movement.
- Stiffness in the shoulder joint.

3. Unspecified Nature
- Lack of specific diagnosis indicating the exact cause of the synovitis or tenosynovitis (e.g., trauma, infection, or underlying systemic condition).

4. Duration of Symptoms
- Symptoms persisting for a significant period, typically more than a few weeks, without clear resolution.

5. Exclusion of Other Conditions
- Other potential causes of shoulder pain and inflammation have been ruled out through clinical evaluation and diagnostic imaging.

6. Impact on Functionality
- Notable impairment in shoulder function, affecting daily activities and range of motion.

7. No Clear Etiology Identified
- Absence of identifiable factors such as rheumatoid arthritis, gout, or other inflammatory diseases that could explain the symptoms.

8. Clinical Assessment Findings
- Positive findings on physical examination, such as tenderness over the shoulder joint and crepitus during movement.

9. Response to Initial Treatment
- Limited or no improvement with conservative treatment measures, such as rest, ice, or anti-inflammatory medications.

10. Follow-Up Evaluation
- Need for further evaluation or referral to a specialist due to persistent symptoms or lack of improvement.

For the ICD code M65.819, which pertains to "Other synovitis and tenosynovitis, unspecified 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. 27369 - Injection procedure for contrast knee arthrography or contrast enhanced CT/MRI knee arthrography.

4. 29826 - Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release.

5. 29827 - Arthroscopy, shoulder, surgical; with rotator cuff repair.

6. 29828 - Arthroscopy, shoulder, surgical; biceps tenodesis.

7. 29824 - Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure).

These CPT codes represent common procedures that may be performed to address conditions associated with synovitis and tenosynovitis of the shoulder. It is important for healthcare providers to select the appropriate CPT code based on the specific procedure performed and the clinical scenario.

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