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v1.0.0
ICD-10 Guide
DiagnosesRight Shoulder Arthritis

Right Shoulder Arthritis

ICD-10 Coding for Right Shoulder Arthritis(M19.011, M13.811)

PRIMARY SPECIALTYOrthopedics
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Right Shoulder Arthritis?
Essential facts and insights about Right Shoulder Arthritis

Key Clinical Considerations:

  • Pain and stiffness in the right shoulder, especially after inactivity
  • X-ray findings showing joint space narrowing, osteophytes, and subchondral sclerosis
  • Limited range of motion and tenderness upon palpation of the shoulder joint

Clinical Information

Clinical Criteria & Documentation Requirements

  • Patient history including onset, duration, and severity of symptoms
  • Specific terminology such as 'osteoarthritis' or 'degenerative joint disease'
  • Examples include detailed descriptions of physical exam findings and imaging results

Coding Guidelines

Usage Guidelines & Examples

  • Usage guidelines: Use M19.011 for primary osteoarthritis and M19.012 for secondary causes.
  • Common errors: Misclassifying the type of arthritis or failing to document the severity.

Code Exclusions

Important Exclusions

  • Excludes conditions such as rotator cuff tears and adhesive capsulitis.
  • Alternative codes may include M75.1 for rotator cuff syndrome.

Related ICD-10 Codes

Primary Codes
M19.011
Primary osteoarthritis of right shoulder
M19.012
Secondary osteoarthritis of right shoulder
Ancillary Codes
M25.511
Differential Codes
M13.811
M19.011

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Orthopedics

Specialty Applications

  • Older adults, athletes with repetitive shoulder use, and individuals with a history of shoulder injuries.
  • Clinical settings include orthopedic clinics, rheumatology practices, and physical therapy centers.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

Documentation requirements?

Include detailed patient history, physical exam findings, and imaging results.

Billing considerations?

Ensure correct ICD-10 codes are used and that documentation supports the diagnosis.