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v1.0.0
ICD-10 Guide
DiagnosesArthritis Right Clavicle

Arthritis Right Clavicle

ICD-10 Coding for Arthritis of the Right Clavicle(M19.011, M19.211)

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

Diagnosis Overview

What is Arthritis Right Clavicle?
Essential facts and insights about Arthritis of the Right Clavicle

Key Clinical Considerations:

  • Patients typically present with localized pain, swelling, and tenderness over the right clavicle.
  • Laboratory tests may show elevated inflammatory markers such as ESR or CRP, but specific tests for rheumatoid factor or anti-CCP may be necessary for differential diagnosis.
  • Physical examination may reveal limited range of motion in the shoulder and tenderness upon palpation of the right clavicle.
  • Imaging studies such as X-rays may show joint space narrowing, osteophyte formation, or subchondral sclerosis in the right clavicle area.
  • Severity can be assessed based on the degree of joint damage observed on imaging and the impact on the patient's daily activities.

Clinical Information

Clinical Criteria & Documentation Requirements

  • Medical records must include a clear diagnosis of arthritis affecting the right clavicle, supported by clinical findings.
  • Terminology such as 'osteoarthritis' or 'rheumatoid arthritis' must be specified to ensure accurate coding.
  • Examples include documenting the patient's pain level, functional limitations, and response to treatment.
  • Medical necessity must be established through documentation of symptoms and the need for diagnostic tests or treatments.
  • Quality measures may require documentation of pain assessments and functional status evaluations.

Coding Guidelines

Usage Guidelines & Examples

  • Use M19.011 for primary osteoarthritis of the right clavicle and M19.211 for secondary osteoarthritis due to previous trauma or other conditions.
  • Do not use these codes for arthritis affecting other joints or for conditions like bursitis or tendinitis.
  • Similar codes include M19.012 (osteoarthritis of the left clavicle) and M19.90 (osteoarthritis, unspecified site).
  • Common errors include misclassifying the type of arthritis or failing to specify laterality.
  • In complex cases, consider the patient's full clinical picture and any co-existing conditions that may affect code selection.

Code Exclusions

Important Exclusions

  • Excludes conditions such as fractures of the clavicle or other types of arthritis affecting different joints.
  • Alternative codes for excluded conditions include S42.001 for a fracture of the right clavicle.
  • Conditions are excluded to ensure accurate representation of the patient's specific diagnosis.
  • Common mistakes include using arthritis codes for acute injuries or misidentifying the type of arthritis.
  • Related but distinct conditions include acromioclavicular joint arthritis or thoracic outlet syndrome.

Related ICD-10 Codes

Primary Codes
M19.011
Primary billable ICD-10 code for primary osteoarthritis of the right clavicle
M19.211
Related or alternative code for secondary osteoarthritis of the right clavicle
Ancillary Codes
Z89.111
Differential Codes
M19.211
M19.011

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Orthopedics

Specialty Applications

  • This diagnosis applies to patients with osteoarthritis affecting the right clavicle.
  • Common patient populations include older adults, individuals with a history of joint injuries, or those with a family history of arthritis.
  • Clinical settings include outpatient orthopedic clinics, rehabilitation centers, and inpatient facilities for surgical interventions.
  • Specialty-specific applications are relevant in orthopedics, rheumatology, and physical therapy.
  • Treatment contexts include conservative management with physical therapy or surgical options like arthroplasty.

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: 'Patient diagnosed with arthritis of the right clavicle based on clinical findings of pain and swelling.'

Template 2

Template: 'Clinical presentation consistent with osteoarthritis including limited range of motion and tenderness.'

Template 3

Template: 'Diagnostic criteria for osteoarthritis met as evidenced by X-ray findings of joint space narrowing.'

Template 4

Template: 'Treatment plan initiated for right clavicle arthritis with physical therapy and pain management.'

Template 5

Template: 'Follow-up care for right clavicle arthritis including monitoring of pain levels and functional status.'

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 diagnosis?

Documentation must include clinical findings, imaging results, and treatment plans.

How does this differ from similar diagnoses?

Differentiation is based on the specific joint affected and the type of arthritis.

What are common billing considerations?

Ensure that the diagnosis is supported by medical necessity and that all services are documented.

What procedures are typically associated?

Common procedures include joint injections, physical therapy, and possibly surgical interventions.

Are there any quality reporting implications?

Quality measures may include tracking pain levels and functional improvements in patients.