ICD Code M67.212

ICD code M67.212 is used to identify a medical condition known as synovial hypertrophy, not elsewhere classified, affecting the left shoulder. Synovial hypertrophy refers to the abnormal enlargement or thickening of the synovial membrane, which is the lining of the joint. This condition can lead to joint pain, swelling, and reduced mobility in the affected shoulder. The code is part of the International Classification of Diseases (ICD) system, which is used by healthcare providers to standardize the diagnosis and classification of diseases for billing, treatment, and statistical purposes.

When to use the ICD code for synovial hypertrophy, not elsewhere classified, left shoulder:

1. Presence of Synovial Hypertrophy
- Documented swelling or thickening of the synovial membrane in the left shoulder joint.

2. Symptoms of Joint Dysfunction
- Limited range of motion in the left shoulder.
- Pain or discomfort during shoulder movement or at rest.

3. Exclusion of Other Diagnoses
- Confirmation that the synovial hypertrophy is not attributable to other specific conditions (e.g., rheumatoid arthritis, osteoarthritis, or other inflammatory joint diseases).

4. Duration of Symptoms
- Symptoms persisting for a significant period, typically beyond acute injury or transient conditions.

5. Imaging Findings
- Radiological evidence (e.g., MRI or ultrasound) indicating synovial thickening or effusion in the left shoulder.

6. Clinical Evaluation
- Comprehensive assessment by a healthcare provider confirming the diagnosis based on physical examination and patient history.

7. Impact on Daily Activities
- Notable interference with daily activities or quality of life due to shoulder pain or dysfunction.

8. Response to Treatment
- Evaluation of the patient's response to initial conservative treatments (e.g., physical therapy, corticosteroid injections) indicating persistent symptoms warranting further classification.

Using the ICD code is appropriate when these diagnostic criteria and symptoms are met, ensuring accurate documentation and billing for the condition.

For the ICD code M67.212, which pertains to synovial hypertrophy of the left 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. 29826 - Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release.

4. 29827 - Arthroscopy, shoulder, surgical; with rotator cuff repair.

5. 29828 - Arthroscopy, shoulder, surgical; biceps tenodesis.

6. 29824 - Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure).

These CPT codes are commonly associated with procedures that may be performed to address conditions related to synovial hypertrophy in the shoulder. It is important for healthcare providers to select the appropriate CPT code based on the specific procedure performed and the clinical scenario. Always ensure that the chosen CPT code aligns with the documented medical necessity and the services provided.

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 codes like M67212. Schedule a demo today to see how RevFind can help ensure you're receiving the full reimbursement you deserve.