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ICD-10 Guide
ICD-10 CodesM02.21

M02.21

Billable

Postimmunization arthropathy, shoulder

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/12/2025

Code Description

ICD-10 M02.21 is a billable code used to indicate a diagnosis of postimmunization arthropathy, shoulder.

Key Diagnostic Point:

Postimmunization arthropathy of the shoulder is a condition characterized by joint pain and inflammation following vaccination. The shoulder joint, a ball-and-socket joint formed by the humeral head and the glenoid cavity of the scapula, allows for a wide range of motion. Postimmunization arthropathy typically presents with pain, swelling, and limited range of motion in the shoulder, often occurring within days to weeks after vaccination. The pathophysiology may involve an autoimmune response triggered by the vaccine, leading to synovitis and joint inflammation. Clinically, patients may report pain during overhead activities, tenderness on palpation, and stiffness, which can significantly impact daily activities and functional mobility. Diagnosis is primarily clinical, supported by patient history and physical examination, with imaging studies used to rule out other causes of shoulder pain.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of post-vaccination immune responses.
  • Involves specific anatomical knowledge of the shoulder joint.
  • Differentiation from other shoulder pathologies is necessary.
  • Documentation must reflect the temporal relationship to vaccination.

Audit Risk Factors

  • Inadequate documentation of vaccination history.
  • Failure to specify laterality of shoulder involvement.
  • Misclassification of the condition as a primary arthropathy.
  • Lack of supporting evidence for the temporal relationship to vaccination.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Orthopedic documentation should include imaging studies (e.g., X-rays, MRI) to assess joint integrity and functional assessments to evaluate range of motion and strength.

Common Clinical Scenarios

Patients presenting with shoulder pain post-vaccination may require surgical intervention if conservative management fails, such as arthroscopy for synovitis.

Billing Considerations

Documenting the severity of joint involvement and functional limitations is crucial for treatment planning.

Rheumatology

Documentation Requirements

Rheumatologic documentation should include laboratory tests for inflammatory markers (e.g., ESR, CRP) and assessments of disease activity.

Common Clinical Scenarios

Patients may present with systemic symptoms indicating a broader autoimmune response, necessitating a comprehensive evaluation.

Billing Considerations

Consideration of other autoimmune conditions that may mimic postimmunization arthropathy is essential.

Physical Medicine

Documentation Requirements

Functional assessments should evaluate mobility, strength, and the need for assistive devices to aid rehabilitation.

Common Clinical Scenarios

Rehabilitation programs focusing on restoring range of motion and strength post-vaccination injury.

Billing Considerations

Addressing mobility limitations and developing a tailored rehabilitation plan is critical.

Coding Guidelines

Inclusion Criteria

Use M02.21 When
  • 10 coding guidelines require specificity in documenting laterality (left or right shoulder) and the severity of the condition
  • Encounter type (initial, subsequent, or sequela) must also be accurately coded

Exclusion Criteria

Do NOT use M02.21 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

Arthrocentesis, aspiration and/or injection into a major joint or bursa

Clinical Scenario

Used when a patient presents with significant swelling and pain in the shoulder post-vaccination.

Documentation Requirements

Document the indication for the procedure, including the patient's vaccination history and clinical findings.

Specialty Considerations

Orthopedic considerations include assessing joint fluid for inflammatory markers.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, enabling better tracking of postimmunization complications and improving patient care through targeted interventions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, enabling better tracking of postimmunization complications and improving patient care through targeted interventions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding musculoskeletal conditions, enabling better tracking of postimmunization complications and improving patient care through targeted interventions.

Resources

Clinical References

  • •
    American Academy of Orthopaedic Surgeons Guidelines
  • •
    American College of Rheumatology Recommendations

Coding & Billing References

  • •
    American Academy of Orthopaedic Surgeons Guidelines
  • •
    American College of Rheumatology Recommendations

Frequently Asked Questions

What are the common symptoms of postimmunization arthropathy?

Common symptoms include joint pain, swelling, stiffness, and limited range of motion in the affected shoulder, typically occurring within days to weeks after vaccination.