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ICD-10 Guide
ICD-10 CodesM67.311

M67.311

Billable

Transient synovitis, right shoulder

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

Code Description

ICD-10 M67.311 is a billable code used to indicate a diagnosis of transient synovitis, right shoulder.

Key Diagnostic Point:

Transient synovitis of the shoulder is a temporary inflammatory condition affecting the synovial membrane of the shoulder joint. It is characterized by pain, swelling, and limited range of motion, often occurring in children and adolescents. The etiology can be idiopathic or secondary to trauma, infection, or systemic inflammatory diseases. Patients typically present with acute shoulder pain, which may be exacerbated by movement. Diagnosis is primarily clinical, supported by imaging studies such as ultrasound or MRI to assess joint effusion and synovial thickening. Treatment usually involves rest, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy. In severe cases, aspiration of the joint may be necessary. The condition is self-limiting, with most patients recovering fully within weeks to months. However, it is crucial to differentiate transient synovitis from more serious conditions such as septic arthritis or osteomyelitis, which require more aggressive intervention.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiation from septic arthritis and other inflammatory conditions
  • Need for precise documentation of symptoms and treatment
  • Variability in presentation among different age groups
  • Potential for misdiagnosis leading to incorrect coding

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document imaging results
  • Misclassification of transient synovitis as a chronic condition
  • Lack of follow-up documentation

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes including history, physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Acute shoulder pain in children, post-traumatic shoulder pain, and differential diagnosis of shoulder conditions.

Billing Considerations

Ensure clear documentation of the duration of symptoms and response to treatment to support the diagnosis.

Pediatrics

Documentation Requirements

Comprehensive history including onset of symptoms, activity level, and any associated systemic symptoms.

Common Clinical Scenarios

Evaluation of a child with shoulder pain and limited range of motion, particularly after a fall or injury.

Billing Considerations

Consider developmental factors and the potential for growth-related issues in the differential diagnosis.

Coding Guidelines

Inclusion Criteria

Use M67.311 When
  • Follow the official ICD
  • CM coding guidelines, ensuring accurate documentation of the condition's acute nature and any associated treatments
  • Include details on the patient's age and any relevant medical history

Exclusion Criteria

Do NOT use M67.311 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

Arthrocentesis, aspiration of a major joint or bursa

Clinical Scenario

Used when joint effusion is present and aspiration is performed.

Documentation Requirements

Document the indication for aspiration, the amount of fluid removed, and any laboratory analysis of the fluid.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is justified based on clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding transient synovitis, enabling better tracking of this condition and its management. The detailed codes help in understanding the prevalence and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding transient synovitis, enabling better tracking of this condition and its management. The detailed codes help in understanding the prevalence and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding transient synovitis, enabling better tracking of this condition and its management. The detailed codes help in understanding the prevalence and treatment outcomes.

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 treatment for transient synovitis?

The primary treatment includes rest, NSAIDs for pain relief, and physical therapy. In some cases, aspiration of the joint may be necessary.

How can transient synovitis be differentiated from septic arthritis?

Transient synovitis typically presents with less severe systemic symptoms and is often self-limiting, while septic arthritis usually involves significant fever, chills, and requires immediate medical intervention.