ICD-10 Guide

Acromioclavicular Joint Osteoarthritis

ICD-10 Coding for Acromioclavicular Joint Osteoarthritis(M19.011, M19.012, M19.111)

PRIMARY SPECIALTYOrthopedics

COMPLEXITYHigh

LAST UPDATED09/15/2025

Sam Tuffun, PT, DPT

Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Acromioclavicular Joint Osteoarthritis?

Acromioclavicular joint osteoarthritis (AC joint OA) is a degenerative joint disease affecting the acromioclavicular joint, which connects the collarbone (clavicle) to the highest point of the shoulder blade (acromion). This condition is characterized by the breakdown of cartilage, leading to pain, swelling, and reduced range of motion. Key clinical points include: 1) Commonly seen in older adults and those with a history of shoulder injuries; 2) Symptoms often worsen with overhead activities; 3) Diagnosis is confirmed through clinical examination and imaging studies. Etiology includes age-related wear and tear, repetitive stress, and previous trauma. Pathophysiology involves cartilage degeneration, bone spurs formation, and synovitis. Clinical presentation typically includes localized pain at the AC joint, tenderness, and possible crepitus during shoulder movement. Typical use cases for this diagnosis code include patients presenting with shoulder pain and limited mobility, particularly in the context of chronic shoulder conditions.

Key Clinical Considerations:

Diagnosis requires clinical evidence of joint pain localized to the AC joint, particularly during shoulder abduction or adduction.
Signs include tenderness over the AC joint, swelling, and decreased range of motion; symptoms may include pain with overhead activities.
Resolution criteria involve significant reduction in pain and restoration of shoulder function following conservative treatment.
Imaging findings may include joint space narrowing, osteophyte formation, and subchondral sclerosis visible on X-rays.

Clinical Information

Clinical Criteria & Documentation Requirements

Documentation must include a detailed history of symptoms, physical examination findings, and imaging results.
Compliant documentation example: 'Patient reports shoulder pain with overhead activities, tenderness noted at the AC joint.' Non-compliant example: 'Patient has shoulder pain.'
Template phrases include: 'Patient diagnosed with AC joint OA based on clinical findings and imaging results.'
Medical necessity documentation should justify the need for imaging or treatment based on the severity of symptoms and impact on daily activities.

Coding Guidelines

Usage Guidelines & Examples

Use this code for patients with confirmed AC joint OA presenting with pain and functional limitations; for example, a patient unable to lift their arm due to pain.
Do not use this code for patients with acute traumatic injuries to the shoulder or other types of shoulder arthritis.
Correct usage example: 'M19.011 - Primary osteoarthritis, right acromioclavicular joint'; incorrect usage: 'M19.90 - Osteoarthritis, unspecified site.'
Common errors include using the code for non-arthritic conditions; avoid this by ensuring a clear diagnosis of osteoarthritis.

Code Exclusions

Important Exclusions

Excluded conditions include acute shoulder injuries (e.g., fractures, dislocations) as they require different management.
Alternative codes for exclusions may include S43.001A for acromioclavicular joint dislocation.
Common exclusion errors involve misdiagnosing acute injuries as chronic osteoarthritis; ensure accurate history-taking.
Certain conditions are excluded to maintain coding specificity and avoid incorrect treatment pathways.

Specialty Focus

Primary Specialty

Orthopedics

Specialty Applications

This diagnosis applies to patients with chronic shoulder pain, particularly in older adults or those with a history of shoulder injuries.
Appropriate clinical scenarios include patients presenting with pain exacerbated by overhead activities or lifting.
Applicable in various practice settings, including outpatient orthopedic clinics and rehabilitation facilities.
Specialty-specific considerations include the need for orthopedic evaluation and potential surgical interventions in severe cases.

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

Template 1

Template: 'Acromioclavicular joint osteoarthritis diagnosed based on clinical findings and X-ray results.'

Template 2

Template: 'Patient presents with shoulder pain consistent with acromioclavicular joint osteoarthritis.'

Template 3

Template: 'Diagnostic criteria met: tenderness over AC joint, imaging shows osteophyte formation.'

Template 4

Template: 'Treatment plan includes physical therapy and possible corticosteroid injection for acromioclavicular joint osteoarthritis.'

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

What documentation is required for this code?

Comprehensive documentation including patient history, physical exam findings, and imaging results.

When should this code be used vs similar codes?

Use this code for chronic AC joint OA; similar codes may apply to other types of shoulder arthritis.

What are common billing issues with this code?

Issues may arise from insufficient documentation; ensure all clinical findings are clearly recorded.

What procedures are commonly associated?

Related CPT codes may include shoulder arthroscopy or corticosteroid injections for symptomatic relief.

What is Acromioclavicular Joint Osteoarthritis?

Key Clinical Considerations:

Diagnosis requires clinical evidence of joint pain localized to the AC joint, particularly during shoulder abduction or adduction.
Signs include tenderness over the AC joint, swelling, and decreased range of motion; symptoms may include pain with overhead activities.
Resolution criteria involve significant reduction in pain and restoration of shoulder function following conservative treatment.
Imaging findings may include joint space narrowing, osteophyte formation, and subchondral sclerosis visible on X-rays.

Acromioclavicular Joint Osteoarthritis

Diagnosis Overview

Key Clinical Considerations:

Clinical Information

Clinical Criteria & Documentation Requirements

Coding Guidelines

Usage Guidelines & Examples

Code Exclusions

Important Exclusions

Related ICD-10 Codes

Related CPT Codes

Specialty Focus

Primary Specialty

Specialty Applications

Coding Complexity

Documentation

Documentation Templates

Template 1

Template 2

Template 3

Template 4

Billing Information

Billing Considerations

Common Issues

Frequently Asked Questions

What documentation is required for this code?

When should this code be used vs similar codes?

What are common billing issues with this code?

What procedures are commonly associated?

Acromioclavicular Joint Osteoarthritis

Diagnosis Overview

Key Clinical Considerations:

Clinical Information

Clinical Criteria & Documentation Requirements

Coding Guidelines

Usage Guidelines & Examples

Code Exclusions

Important Exclusions

Related ICD-10 Codes

Related CPT Codes

Specialty Focus

Primary Specialty

Specialty Applications

Coding Complexity

Documentation

Documentation Templates

Template 1

Template 2

Template 3

Template 4

Billing Information

Billing Considerations

Common Issues

Frequently Asked Questions

What documentation is required for this code?

When should this code be used vs similar codes?

What are common billing issues with this code?

What procedures are commonly associated?