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ICD-10 Guide
ICD-10 CodesM87.219

M87.219

Billable

Osteonecrosis due to previous trauma, unspecified shoulder

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M87.219 is a billable code used to indicate a diagnosis of osteonecrosis due to previous trauma, unspecified shoulder.

Key Diagnostic Point:

Osteonecrosis, also known as avascular necrosis, is a condition characterized by the death of bone tissue due to a lack of blood supply. In the case of M87.219, the osteonecrosis is specifically attributed to previous trauma affecting the shoulder region, although the exact site within the shoulder is unspecified. This condition can arise after fractures, dislocations, or other traumatic injuries that compromise the vascular supply to the bone. The shoulder joint, being a complex structure involving the humerus, scapula, and clavicle, can be particularly susceptible to osteonecrosis following trauma. Symptoms typically include pain, limited range of motion, and potential joint dysfunction. Diagnosis is often confirmed through imaging studies such as MRI or X-rays, which can reveal changes in bone density and structure. Treatment options may vary from conservative management, including physical therapy and pain relief, to surgical interventions like joint replacement in severe cases. Understanding the underlying cause of osteonecrosis is crucial for effective management and prevention of further complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of trauma history and its impact on bone health
  • Differentiation from other types of osteonecrosis
  • Need for precise documentation of previous trauma
  • Potential for co-morbid conditions affecting bone health

Audit Risk Factors

  • Inadequate documentation of prior trauma
  • Failure to specify the shoulder joint involved
  • Misclassification with other osteonecrosis codes
  • Lack of imaging studies to support diagnosis

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed history of trauma, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with shoulder pain following a fracture or dislocation.

Billing Considerations

Ensure clear documentation of the mechanism of injury and any prior treatments.

Physical Medicine and Rehabilitation

Documentation Requirements

Functional assessments and rehabilitation goals.

Common Clinical Scenarios

Patients undergoing rehabilitation post-trauma to the shoulder.

Billing Considerations

Document progress and response to therapy to support ongoing treatment.

Coding Guidelines

Inclusion Criteria

Use M87.219 When
  • According to ICD
  • 10 guidelines, M87
  • 219 should be used when osteonecrosis is confirmed to be due to previous trauma, and the specific site is not documented
  • Coders should ensure that the trauma history is well
  • documented and that the diagnosis is supported by imaging findings

Exclusion Criteria

Do NOT use M87.219 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 for joint pain management in patients with osteonecrosis.

Documentation Requirements

Document the joint involved, reason for aspiration/injection, and any imaging findings.

Specialty Considerations

Orthopedic specialists should ensure clear linkage between the procedure and the diagnosis.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of osteonecrosis, improving the ability to capture the nuances of trauma-related cases. This specificity aids in better tracking of patient outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of osteonecrosis, improving the ability to capture the nuances of trauma-related cases. This specificity aids in better tracking of patient outcomes and resource allocation.

Reimbursement & Billing Impact

reimbursement and to avoid claim denials.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between osteonecrosis and osteomyelitis?

Osteonecrosis is the death of bone tissue due to lack of blood supply, often following trauma, while osteomyelitis is an infection of the bone. The treatment and coding for these conditions differ significantly.