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ICD-10 Guide
DiagnosesRotator Cuff Repair

Rotator Cuff Repair

ICD-10 Coding for Rotator Cuff Repair(S46.011A, M75.111)

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

Diagnosis Overview

What is Rotator Cuff Repair?
Essential facts and insights about Rotator Cuff Repair

Key Clinical Considerations:

  • Shoulder pain and weakness
  • Imaging studies (MRI, Ultrasound) showing rotator cuff tears
  • Limited range of motion and tenderness during shoulder examination

Clinical Information

Clinical Criteria & Documentation Requirements

  • Patient history and physical examination findings
  • Imaging results and surgical notes
  • Specific terminology such as 'full-thickness tear' or 'partial-thickness tear'

Coding Guidelines

Usage Guidelines & Examples

  • Follow guidelines for coding rotator cuff repairs based on the type of tear.
  • Common errors include incorrect coding of the tear type or omitting necessary documentation.

Code Exclusions

Important Exclusions

  • Acute traumatic rotator cuff tears (specific codes apply)
  • Non-surgical management of rotator cuff injuries

Related ICD-10 Codes

Primary Codes
726.10
Rotator cuff tear or rupture, not specified as traumatic
726.19
Other specified disorders of rotator cuff
Ancillary Codes
Z91.128
Differential Codes
M75.111
S46.011A

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Orthopedic Surgery

Specialty Applications

  • Adults with rotator cuff injuries
  • Outpatient surgical settings and inpatient facilities

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, imaging results, and surgical notes.

Billing considerations?

Ensure accurate coding of the procedure and diagnosis to avoid denials.