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v1.0.0
ICD-10 Guide
ICD-10 CodesM67.319

M67.319

Billable

Transient synovitis, unspecified shoulder

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

Code Description

ICD-10 M67.319 is a billable code used to indicate a diagnosis of transient synovitis, unspecified 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 resulting from trauma, overuse, or infection. The condition is more common in children but can occur in adults as well. Symptoms typically include localized pain, tenderness, and sometimes effusion in the shoulder joint. Diagnosis is primarily clinical, supported by imaging studies such as ultrasound or MRI to assess joint effusion and rule out other conditions. Treatment usually involves rest, ice, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy. In severe cases, aspiration of the joint may be necessary. The prognosis is generally good, with most patients recovering fully within a few weeks. However, recurrent episodes can occur, necessitating further evaluation to rule out underlying conditions such as juvenile idiopathic arthritis or other inflammatory arthropathies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and symptoms
  • Differentiation from other shoulder conditions
  • Need for imaging studies to confirm diagnosis
  • Potential for co-existing conditions affecting treatment

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify laterality when applicable
  • Lack of follow-up documentation
  • Misinterpretation of imaging results

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients presenting with shoulder pain after sports injuries or falls.

Billing Considerations

Ensure to document any prior shoulder injuries or surgeries that may affect the current condition.

Pediatrics

Documentation Requirements

Thorough history of present illness, including onset of symptoms and any associated systemic symptoms.

Common Clinical Scenarios

Children presenting with acute shoulder pain and limited mobility, often following minor trauma.

Billing Considerations

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

Coding Guidelines

Inclusion Criteria

Use M67.319 When
  • According to ICD
  • 10 guidelines, M67
  • 319 should be used when the specific laterality of the shoulder is not documented
  • Coders should ensure that the diagnosis is supported by clinical findings and imaging results

Exclusion Criteria

Do NOT use M67.319 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

20610CPT Code

Arthrocentesis, aspiration of the shoulder joint

Clinical Scenario

Used when joint effusion is present and needs to be drained.

Documentation Requirements

Document indication for aspiration, amount of fluid removed, and any findings.

Specialty Considerations

Orthopedic specialists should ensure proper technique and follow-up care.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of transient synovitis, improving the accuracy of data collection and reimbursement processes. It has also facilitated better tracking of patient outcomes and treatment efficacy.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of transient synovitis, improving the accuracy of data collection and reimbursement processes. It has also facilitated better tracking of patient outcomes and treatment efficacy.

Reimbursement & Billing Impact

reimbursement processes. It has also facilitated better tracking of patient outcomes and treatment efficacy.

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 typical duration of transient synovitis?

Transient synovitis typically resolves within a few weeks, but some patients may experience recurrent episodes.