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v1.0.0
ICD-10 Guide
ICD-10 CodesM87.319

M87.319

Billable

Other secondary osteonecrosis, unspecified shoulder

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

Code Description

ICD-10 M87.319 is a billable code used to indicate a diagnosis of other secondary osteonecrosis, unspecified shoulder.

Key Diagnostic Point:

Osteonecrosis, also known as avascular necrosis, is a condition characterized by the death of bone tissue due to a lack of blood supply. In the case of M87.319, the osteonecrosis is secondary, meaning it is a result of another underlying condition or factor, such as trauma, corticosteroid use, or excessive alcohol consumption. The unspecified shoulder designation indicates that the specific anatomical location within the shoulder joint is not detailed. This condition can lead to severe pain, limited range of motion, and eventual joint collapse if not addressed. Patients may present with symptoms such as shoulder pain, stiffness, and swelling. Diagnosis typically involves imaging studies like MRI or X-rays to assess bone integrity and blood flow. Treatment options may include conservative management with pain relief, physical therapy, or surgical interventions such as core decompression or joint replacement, depending on the severity of the condition. Understanding the underlying causes and appropriate management strategies is crucial for effective treatment and recovery.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between primary and secondary osteonecrosis.
  • Identifying the underlying causes contributing to the condition.
  • Documenting the unspecified nature of the shoulder involvement.
  • Understanding the implications of related conditions such as osteomyelitis.

Audit Risk Factors

  • Inadequate documentation of the underlying cause of osteonecrosis.
  • Failure to specify the anatomical location of the shoulder.
  • Misclassification of primary vs. secondary osteonecrosis.
  • Lack of imaging or clinical evidence to support the diagnosis.

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed clinical notes on the patient's history, physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with shoulder pain and limited mobility, often following corticosteroid therapy or trauma.

Billing Considerations

Ensure that the documentation clearly states the cause of osteonecrosis and the specific shoulder joint affected.

Rheumatology

Documentation Requirements

Comprehensive assessment of systemic conditions that may contribute to osteonecrosis, including autoimmune disorders.

Common Clinical Scenarios

Patients with a history of systemic lupus erythematosus or other rheumatologic conditions presenting with joint pain.

Billing Considerations

Document any relevant laboratory findings and treatment history that may influence the diagnosis.

Coding Guidelines

Inclusion Criteria

Use M87.319 When
  • According to the ICD
  • CM coding guidelines, M87
  • 319 should be used when the osteonecrosis is secondary and the specific cause is not documented
  • Coders should ensure that the documentation supports the diagnosis and that any underlying conditions are also coded appropriately

Exclusion Criteria

Do NOT use M87.319 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Arthroscopy, shoulder, diagnostic, with or without synovial biopsy

Clinical Scenario

Used when evaluating shoulder pain that may be due to osteonecrosis.

Documentation Requirements

Document the reason for the procedure and findings.

Specialty Considerations

Orthopedic surgeons should ensure that the clinical rationale for the procedure is clearly documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of osteonecrosis, improving the ability to capture secondary causes and better reflect the complexity of the condition.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of osteonecrosis, improving the ability to capture secondary causes and better reflect the complexity of the condition.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of osteonecrosis, improving the ability to capture secondary causes and better reflect the complexity of the condition.

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 difference between primary and secondary osteonecrosis?

Primary osteonecrosis occurs without an identifiable cause, while secondary osteonecrosis is due to underlying conditions such as trauma, corticosteroid use, or other medical issues.