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ICD-10 Guide
ICD-10 CodesM67.211

M67.211

Billable

Synovial hypertrophy, not elsewhere classified, right shoulder

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

Code Description

ICD-10 M67.211 is a billable code used to indicate a diagnosis of synovial hypertrophy, not elsewhere classified, right shoulder.

Key Diagnostic Point:

Synovial hypertrophy refers to the abnormal enlargement of the synovial membrane, which lines the joints and produces synovial fluid for lubrication. In the context of the right shoulder, this condition can arise from various underlying issues, including inflammatory arthritis, repetitive strain injuries, or chronic joint conditions. The hypertrophy may lead to joint pain, swelling, and decreased range of motion. Patients often present with symptoms such as stiffness, tenderness, and discomfort during movement. Diagnosis typically involves a combination of clinical evaluation, imaging studies like MRI or ultrasound, and sometimes arthroscopy to assess the synovial tissue directly. Treatment options may include physical therapy, corticosteroid injections, or surgical interventions to repair or remove the affected synovial tissue. Understanding the nuances of synovial disorders is crucial for accurate coding and management, as they can significantly impact patient outcomes and treatment plans.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between various types of synovial disorders.
  • Understanding the relationship between synovial hypertrophy and other conditions like tenosynovitis.
  • Identifying the specific joint involved and its implications for treatment.
  • Navigating the documentation requirements for surgical interventions.

Audit Risk Factors

  • Inadequate documentation of the clinical rationale for the diagnosis.
  • Failure to specify the affected joint in the medical record.
  • Lack of supporting imaging studies or clinical findings.
  • Improper coding of associated conditions or procedures.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with shoulder pain, swelling, and limited range of motion due to synovial hypertrophy.

Billing Considerations

Ensure that all surgical interventions are documented, including pre-operative assessments and post-operative outcomes.

Rheumatology

Documentation Requirements

Comprehensive history of joint symptoms, laboratory tests, and response to previous treatments.

Common Clinical Scenarios

Patients with inflammatory arthritis leading to synovial hypertrophy.

Billing Considerations

Document the progression of symptoms and any systemic involvement to support the diagnosis.

Coding Guidelines

Inclusion Criteria

Use M67.211 When
  • According to ICD
  • 10 coding guidelines, M67
  • 211 should be used when synovial hypertrophy is documented without a more specific diagnosis
  • Coders must ensure that the documentation supports the diagnosis and that no other codes are more appropriate

Exclusion Criteria

Do NOT use M67.211 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

29827CPT Code

Arthroscopy, shoulder, diagnostic, with or without synovial biopsy

Clinical Scenario

Used when a patient with synovial hypertrophy undergoes arthroscopy for evaluation.

Documentation Requirements

Document indications for surgery, findings during the procedure, and post-operative care.

Specialty Considerations

Orthopedic surgeons should ensure that the surgical necessity is well-documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like synovial hypertrophy, improving the accuracy of patient records and facilitating better treatment planning.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like synovial hypertrophy, improving the accuracy of patient records and facilitating better treatment planning.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like synovial hypertrophy, improving the accuracy of patient records and facilitating better treatment planning.

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 primary cause of synovial hypertrophy?

Synovial hypertrophy is often caused by chronic inflammation, which can result from conditions such as arthritis, repetitive joint use, or injury.

How is synovial hypertrophy diagnosed?

Diagnosis typically involves a physical examination, imaging studies like MRI or ultrasound, and sometimes arthroscopy to visualize the synovial membrane.