ICD Code M65.919

ICD code M65.919 is used to identify a medical condition characterized by inflammation of the synovial membrane and tendon sheath in the shoulder, where the specific type of synovitis and tenosynovitis is not specified. This code is applicable when a healthcare provider diagnoses a patient with these conditions in the shoulder but does not provide further details about the specific nature or cause of the inflammation. It is a part of the International Classification of Diseases (ICD) system, which is used to standardize diagnoses and facilitate efficient billing and data analysis in healthcare settings.

When to use the ICD code M65919 for unspecified synovitis and tenosynovitis of the unspecified shoulder, consider the following diagnostic criteria and symptoms:

1. Joint Pain: Patient reports pain in the shoulder joint, which may be exacerbated by movement.

2. Swelling: Observable swelling around the shoulder area, indicating inflammation.

3. Limited Range of Motion: Patient experiences difficulty or pain when attempting to move the shoulder, suggesting restricted mobility.

4. Tenderness: Palpation of the shoulder reveals tenderness, indicating inflammation of the synovial tissue.

5. Stiffness: Patient reports stiffness in the shoulder, particularly after periods of inactivity.

6. History of Overuse or Injury: Patient has a history of repetitive shoulder use or a recent injury that may contribute to inflammation.

7. Absence of Specific Diagnosis: No specific underlying condition (e.g., rheumatoid arthritis, osteoarthritis) has been identified that explains the symptoms.

8. Imaging Results: Imaging studies (e.g., X-rays, MRI) show signs of inflammation without definitive evidence of structural damage or specific pathology.

9. Duration of Symptoms: Symptoms have persisted for a duration that warrants further investigation but do not meet criteria for a more specific diagnosis.

10. Response to Treatment: Symptoms do not significantly improve with conservative treatment measures, indicating a need for further evaluation.

These criteria can guide healthcare providers in determining the appropriate use of the ICD code for documentation and billing purposes.

For the ICD code M65.919, which refers to unspecified synovitis and tenosynovitis of an 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. 20550 - Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia").

4. 20551 - Injection(s); single tendon origin/insertion.

5. 73030 - Radiologic examination, shoulder; complete, minimum of two views.

6. 97035 - Application of a modality to 1 or more areas; ultrasound, each 15 minutes.

7. 97110 - Therapeutic exercises to develop strength and endurance, range of motion, and flexibility (each 15 minutes).

These CPT codes are commonly used for procedures and treatments associated with conditions like synovitis and tenosynovitis of the shoulder. It's important for healthcare providers to select the appropriate CPT code based on the specific treatment or procedure performed. Always ensure that the chosen CPT code accurately reflects the service provided to ensure proper billing and reimbursement.

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