What are ICD-10 codes?
This internationally recognized classification of diseases is copyrighted and updated by the World Health Organization. It stands for International Statistical Classification of Diseases and Related Health Problems, (ICD-10, the number 10 represents the latest revision or version). These alphanumeric codes are used by the smallest, most rural doctor to every specialized doctors’ practice in the country, the biggest health insurance companies and international health boards in order to represent medical diagnoses. They are used by Health insurance companies when processing claims and the same codes are also used in worldwide statistics, for example, when tracking diseases, mortality or major health epidemics. It is an international language for people working in the health sector where information can be extracted and understood on an international level. The National Center for Health Statistics is the body responsible for ICD-10 review in the United States.
ICD-10 Codes Shoulder CPT Codes ICD-10 Codes Elbow ICD-10 Codes Fracture
ICD-10 Codes Shoulder
| Left | Right | Code is unclear to laterality | Add-on Code | |
|---|---|---|---|---|
| Complete Rotator Cuff Tear | M75.122 | M75.121 | ||
| Partial Rotator Cuff Tear | M75.112 | M75.111 | ||
| Calcific tendonitis of the shoulder | M75.32 | M75.31 | ||
| Adhesive Capsulitis (Frozen Shoulder) | M75.02 | M75.01 | ||
| Impingement Syndrome (Rotator Cuff Syndrome) | M75.102 | M75.101 | ||
| Acromioclavicular (AC) Joint Pain/Arthritis | M19.012 | M19.011 | ||
| Rotator Cuff Sprain | S43.422A | S43.421A | ||
| Loose body in Shoulder | M24.012 | M24.011 | ||
| Acromioclavicular (AC) Joint Separation (any grade) | S43.102A | S43.101A | ||
| Labral Tear of the shoulder | S43.432A | S43.431A | ||
| Shoulder instability | M25.312 | M25.311 | ||
| Recurrent shoulder dislocation | M24.412 | M24.411 | ||
| Anterior shoulder dislocation | S43.015A | S43.014A | ||
| Posterior shoulder dislocation | S43.035A | S43.034A | ||
| Inferior Shoulder dislocation | S43.005A | S43.004A | ||
| HAGL - Humeral avulsion of inferior glenohumeral ligaments | S43.492A | S43.491A | ||
| Bankart Lesion | S43.492A | S43.491A | ||
| Hill-Sachs deformity/fracture | S42.292A | S42.291A | ||
| Pectoralis Major Rupture | S29.011A | |||
| Biceps Tenosynovitis | M75.22 | M75.21 | ||
| Rupture of long head of biceps | S46.112A | S46.111A | ||
| Rotator Cuff Arthropathy | M12.812 | M12.811 | ||
| Primary Osteoarthritis of the shoulder | M19.012 | M19.011 | ||
| Post-Traumatic OA of the shoulder | M19.112 | M19.111 | ||
| Rheumatoid Arthritis of the shoulder | M06.012 | M06.011 | ||
| Avascular Necrosis of the Humeral Head | M87.012 | M87.011 | ||
| Staphylococcal septic arthritis of the shoulder | M00.012 | M00.011 | ||
| Streptococcal septic arthritis of the shoulder | M00.212 | M00.211 | ||
| Pneumococcal septic arthritis of the shoulder | M00.112 | M00.111 | ||
| Other bacteria, septic arthritis of the shoulder | M00.812 | M00.811 | ||
| Unspecified bacteria, septic arthritis of the shoulder | M00.9 | |||
| Acute Gout Shoulder | M10.012 | M10.011 | ||
| Infected Shoulder Prosthesis | T84.59XA | Z96.619 | ||
| Dislocated Shoulder Prosthesis | T84.028A | Z96.619 | ||
| Broken Shoulder Prosthesis | T84.018A | Z96.619 | ||
| Loosening of shoulder replacement | T84.038A | Z96.619 | ||
| Winged Scapula | M21.80 | |||
| Suprascapular Nerve Entrapment | G56.82 | G56.81 | ||
| Thoracic Outlet Syndrome | G54.0 |
Shoulder and Elbow CPT Codes
| Description | CPT Code |
|---|---|
| Arthroscopic rotator cuff repair | 29827 |
| Arthroscopic subacromial decompression | 29826 |
| Arthroscopic biceps tenodesis | 29828 |
| Arthroscopic distal clavicle excision | 29824 |
| Arthroscopic extensive debridement | 29823 |
| Arthroscopic limited debridement | 29822 |
| Arthroscopic complete synovial debridement | 29821 |
| Arthroscopic partial synovial debridement | 29820 |
| Arthroscopic Loose body removal | 29819 |
| Arthroscopic labral repair or capsulorrhaphy | 29806 |
| Arthroscopic SLAP Repair | 29807 |
| Arthroscopic Hill-Sachs Remplissage | 29827 |
| Arthroscopic Latarjet | 29999, open equivalent 23462 |
| Arthroscopic posterior bone block | 29999, open equivalent 23465 |
| Arthroscopic supra scapular nerve release | 29999 |
| Total shoulder/reverse shoulder arthroplasty | 23472 |
| Modified l'episcopo | 23397 |
| Revision shoulder arthroplasty one component w/allograft | 23473 |
| Revision shoulder arthroplasty both components w/allograft | 23474 |
| Shoulder hemiarthroplasty | 23470 |
| Bone graft | 20900 |
| Pectoralis major repair | 24341 |
| Pectoralis major transfer | 23395 |
| Open long head biceps tenodesis | 24340 |
| MUA shoulder | 23700 |
| Shoulder fusion | 23800 |
| Hardware removal | 20680 |
| AC reconstruction without graft | 23550 |
| AC reconstruction with graft | 23552 |
| Open distal clavicle excision | 23120 |
| Clavicle ORIF | 23515 |
| ORIF Proximal humerus | 23615 |
| Proximal humerus hemiarthroplasty for fracture | 23616 |
| ORIF Greater tuberosity | 23630 |
| Open shoulder reduction with ORIF GT | 23670 |
| Open shoulder reduction with proximal humerus ORIF | 23680 |
| ORIF humerus with plates | 24515 |
| IM nailing of humerus | 24516 |
| ORIF Scapula - glenoid, scapular body fracture, acromion | 23585 |
| Description | CPT Code |
|---|---|
| Arthroscopy elbow diagnostic | 29830 |
| Arthroscopy elbow loose body removal | 29834 |
| Arthroscopy elbow partial synovectomy | 29835 |
| Arthroscopy elbow complete synovectomy | 29836 |
| Arthroscopy elbow limited debridement | 29837 |
| Arthroscopy elbow extensive debridement | 29838 |
| Distal Triceps Reconstruction (insertion) | 24342 |
| Distal Biceps Reconstruction (insertion) | 24342 |
| Medial or Lateral epicondyle debridement | 24358 |
| Medial or Lateral epicondyle debridement with reattachment | 24359 |
| Olecranon bursectomy | 24105 |
| Reconstruction of LCL elbow with graft | 24344 |
| Repair of LCL elbow with local tissue | 24343 |
| Reconstruction of MCL elbow with graft | 24346 |
| Repair of MCL elbow with local tissue | 24345 |
| Excision bone spur olecranon | 24120 |
| Open Extensive debridement of the elbow | 24006 |
| Open release of elbow with bone | 24149 |
| Radial Head Arthroplasty | 24366 |
| Total Elbow Arthroplasty | 24363 |
| Revision Total Elbow Arthroplasty; One Component | 24370 |
| Revision Total Elbow Arthroplasty; Both Components | 24371 |
| Interposition Elbow Arthroplasty | 24360 |
| MUA of Elbow | 23700 |
| Radial Head Excision | 24130 |
| Elbow arthrodesis | 24800 |
| Implant Removal | 24160 |
| Radial head implant removal | 24164 |
| Olecranon Fracture ORIF | 24685 |
| Coronoid Fracture ORIF | 24685 |
| ORIF Distal humerus fracture without intercondylar extension | 24545 |
| ORIF Distal humerus fracture with intercondylar extension | 24546 |
| ORIF Medial or Lateral humeral condyle | 24579 |
| ORIF Medial or lateral epicondyle of the distal humerus | 24575 |
| Open treatment of Elbow Fracture Dislocation | 24586 |
| Open treatment of Elbow Fracture Dislocation with arthroplasty | 24587 |
| Open treatment of Acute or Chronic Elbow Dislocation | 24615 |
| ORIF of Monteggia Elbow Fracture | 24635 |
| ORIF of Radial head or neck fracture | 24665 |
| Ulnar Nerve Transposition | 64718 |
ICD-10 Codes Elbow
| Left | Right | Code is unclear to laterality | Add-on Code | |
|---|---|---|---|---|
| Anterior elbow dislocation | S53.115A | S53.114A | ||
| Posterior elbow dislocation | S53.125A | S53.124A | ||
| Medial elbow dislocation | S53.135A | S53.134A | ||
| Lateral elbow dislocation | S53.145A | S53.144A | ||
| Ulnar collateral ligament of the elbow tear or sprain | S53.422A | S53.421A | ||
| Radial collateral ligament of the elbow tear or sprain | S53.432A | S53.431A | ||
| Elbow Instability | M25.322 | M25.321 | ||
| Lateral epicondylitis (tennis elbow) | M77.12 | M77.11 | ||
| Medial epicondylitis (golferÕs elbow) | M77.02 | M77.01 | ||
| Olecranon bursitis | M70.22 | M70.21 | ||
| Septic olecranon bursitis | M71.122 | M71.121 | B96.89 | |
| Loose body elbow | M24.022 | M24.021 | ||
| Primary Osteoarthritis of the elbow | M19.022 | M19.021 | ||
| Post Traumatic OA of the elbow | M19.122 | M19.121 | ||
| Rheumatoid Arthritis of the elbow | M05.722 | M05.721 | ||
| Infected Elbow Prosthesis | T84.59XA | Z96.619 | ||
| Dislocated Elbow Prosthesis | T84.028A | Z96.619 | ||
| Broken Elbow Prosthesis | T84.018A | Z96.619 | ||
| Staphylococcal septic arthritis of the elbow | M00.022 | M00.021 | ||
| Streptococcal septic arthritis of the elbow | M00.222 | M00.221 | ||
| Pneumococcal septic arthritis of the elbow | M00.122 | M00.121 | ||
| Other bacteria, septic arthritis of the elbow | M00.822 | M00.821 | ||
| Unspecified bacteria, septic arthritis of the elbow | M00.9 | |||
| Acute Gout Elbow | M10.022 | M10.021 | ||
| Distal biceps rupture | S46.212A | S46.211A | ||
| Distal triceps rupture | S46.312A | S46.311A |
Shoulder and Elbow Fracture ICD-10 Codes
| Fracture Location | Left Displaced | Right Displaced | Left Nondisplaced | Right Nondisplaced |
|---|---|---|---|---|
| Sternal end of clavicle fracture, Anterior displacement | S42.012A | S42.011A | S42.018A | S42.017A |
| Sternal end of clavicle fracture, posterior displacement | S42.015A | S42.014A | S42.018A | S42.017A |
| Clavicle shaft fracture | S42.022A | S42.021A | S42.025A | S42.024A |
| Lateral end of clavicle fracture | S42.032A | S42.031A | S42.035A | S42.034A |
| Coracoid Process Fracture | S42.132A | S42.131A | S42.135A | S42.134A |
| Scapular Body Fracture | S42.112A | S42.111A | S42.115A | S42.114A |
| Acromial Process Fracture | S42.122A | S42.121A | S42.125A | S42.124A |
| Glenoid Cavity Fracture | S42.142A | S42.141A | S42.145A | S42.144A |
| 2-part proximal humerus surgical neck fracture | S42.222A | S42.221A | S42.225A | S42.224A |
| 3-part proximal humerus surgical neck fracture | S42.232A | S42.231A | S42.235A | S42.234A |
| 4-part proximal humerus surgical neck fracture | S42.242A | S42.241A | S42.245A | S42.244A |
| Greater tuberosity fracture | S42.252A | S42.251A | S42.255A | S42.254A |
| Lesser tuberosity fracture | S42.262A | S42.261A | S42.265A | S42.264A |
| Transverse humeral shaft fracture | S42.322A | S42.321A | S42.325A | S42.324A |
| Oblique humeral shaft fracture | S42.332A | S42.331A | S42.335A | S42.334A |
| Spiral humeral shaft fracture | S42.342A | S42.341A | S42.345A | S42.344A |
| Comminuted humeral shaft fracture | S42.352A | S42.351A | S42.355A | S42.354A |
| Segmental humeral shaft fracture | S42.362A | S42.361A | S42.365A | S42.364A |
| Simple supracondylar fracture without intercondylar extension | S42.412A | S42.411A | S42.415A | S42.414A |
| Comminuted supracondylar fracture without intercondylar extension | S42.422A | S42.421A | S42.425A | S42.424A |
| Lateral epicondyle fracture of humerus | S42.432A | S42.431A | S42.435A | S42.434A |
| Medial epicondyle fracture of humerus | S42.442A | S42.441A | S42.445A | S42.444A |
| Lateral condyle fracture of humerus | S42.452A | S42.451A | S42.455A | S42.454A |
| Medial condyle fracture of humerus | S42.462A | S42.461A | S42.465A | S42.464A |
| Transcondylar fracture of humerus | S42.472A | S42.471A | S42.475A | S42.474A |
| Olecranon process fracture with no intra-articular extension | S52.022A | S52.021A | S52.025A | S52.024A |
| Olecranon process fracture with intra-articular extension | S52.032A | S52.031A | S52.035A | S52.034A |
| Coronoid Process fracture | S52.042A | S52.041A | S52.045A | S52.044A |
| Radial Head fracture | S52.122A | S52.121A | S52.125A | S52.124A |
| Radial Neck fracture | S52.132A | S52.131A | S52.135A | S52.134A |
| Greenstick fracture of ulnar shaft | S52.212A | S52.211A | ||
| Transverse fracture of ulnar shaft | S52.222A | S52.221A | S52.225A | S52.224A |
| Oblique fracture of ulnar shaft | S52.232A | S52.231A | S52.235A | S52.234A |
| Spiral fracture of ulnar shaft | S52.242A | S52.241A | S52.245A | S52.244A |
| Comminuted fracture of ulnar shaft | S52.252A | S52.251A | S52.255A | S52.254A |
| Segmental fracture of ulnar shaft | S52.262A | S52.261A | S52.265A | S52.264A |
| Monteggia's fracture | S52.272A | S52.271A | ||
| Greenstick fracture of radial shaft | S52.312A | S52.311A | ||
| Transverse fracture of radial shaft | S52.322A | S52.321A | S52.325A | S52.324A |
| Oblique fracture of radial shaft | S52.332A | S52.331A | S52.335A | S52.334A |
| Spiral fracture of radial shaft | S52.342A | S52.341A | S52.345A | S52.344A |
| Comminuted fracture of radial shaft | S52.352A | S52.351A | S52.355A | S52.354A |
| Segmental fracture of radial shaft | S52.362A | S52.361A | S52.365A | S52.364A |
| Galeazzi's fracture | S52.372A | S52.371A |
On Call Reference
| Diagnosis | ICD-10 Left | ICD-10 Right | CPT Code Description | CPT Code |
|---|---|---|---|---|
| Intertrochanteric Hip Fracture | S72.142A | S72.141A | IM nailing | 27245 |
| Subtrochanteric Hip Fracture | S72.22XA | S72.21XA | IM nailing | 27245 |
| Displaced femoral neck fracture | S72.032A | S72.031A | Hip hemiarthroplasty | 27236 |
| Nondisplaced femoral neck fracture | S72.035A | S72.034A | CRPP Femoral neck | 27235 |
| Patellar tendon rupture | M66.262 | M66.261 | Patellar Tendon Repair | 27380 |
| Quad Tendon Rupture | S76.112A | S76.111A | Quad Tendon Repair | 27385 |
| Tibial Shaft Fracture | S82.232A | S82.231A | Tibial Nailing | 27759 |
| Patellar Fracture | S82.032A | S82.031A | ORIF Patella | 27524 |
| Compartment Syndrome | T79.A22 | T79.A21 | Fasciotomies | 27602 |
| Achilles Rupture | S86.012A | S86.011A | Achilles Repair | 27650 |
| Displaced lateral malleolarl fracture | S82.62XA | S82.61XA | ORIF Lat Mal | 27792 |
| Displaced bimalleolar fracture | S82.842A | S82.841A | ORIF BiMal | 27814 |
| Displaced trimalleolar fracture | S82.852A | S82.851A | ORIF TriMal | 27822 |
| Syndesmotic Injury | S93.432A | S93.431A | Syndesmosis | 27829 |
Note on Trauma Codes (S ICD-10 codes): A implies initial evaluation or first time treating patient with a closed injury, B is open fracture Gustilo-Anderson Types 1/2, C is Gustilo-Anderson Type 3.
E/M Coding
| Code | HX | PE | MDM | Time |
|---|---|---|---|---|
| 99201 | PF | PF | SF | 10 |
| 99202 | EPF | EPF | SF | 20 |
| 99203 | D | D | L | 30 |
| 99204 | C | C | M | 45 |
| 99205 | C | C | H | 60 |
| 99211 | N/A | N/A | N/A | 5 |
| 99212 | PF | PF | SF | 10 |
| 99213 | EPF | EPF | L | 15 |
| 99214 | D | D | M | 25 |
| 99215 | C | C | H | 40 |
| 99241 | PF | PF | SF | 15 |
| 99242 | EPF | EPF | SF | 30 |
| 99243 | D | D | L | 40 |
| 99244 | C | C | M | 60 |
| 99245 | C | C | H | 80 |
| 99221 | D/C | D/C | SF/L | 30 |
| 99222 | C | C | M | 50 |
| 99223 | C | C | H | 70 |
| 99231 | PF | PF | SF/L | 15 |
| 99232 | EPF | EPF | M | 25 |
| 99233 | D | D | H | 35 |
| 99251 | PF | PF | SF | 20 |
| 99252 | EPF | EPF | SF | 40 |
| 99253 | D | D | L | 55 |
| 99254 | C | C | M | 80 |
| 99255 | C | C | H | 110 |
99211-99215 Office Return
99241-99245 Office New or Return Consult
99221-99223 Inpatient Initial
99231-99233 Inpatient Subsequent
99251-99255 Inpatient Initial Consult
Understanding ICD-10 Codes
Each ICD-10 code has numbers and letters, from 3-7 characters. Every code represents a specific diagnosis with particular details.
The ICD-10 code for frozen shoulder, for example, is M75.0 (Adhesive capsulitis of unspecified shoulder). The M75 part of the code tells the user that the diagnosis refers to a shoulder lesion. The number that follows tells the user if it is the right shoulder “.01” , left shoulder “.02” or unspecified “0”.
Adhesive capsulitis of right shoulder – M75.01
Adhesive capsulitis of left shoulder – M75.02
In the case of a labral tear in the shoulder the ICD code would be S43.439 – the user would recognize this code to be a superior glenoid labrum lesion of unspecified shoulder. By changing the last digit of the code, to a 1 or 2, the code specifies the shoulder where 1 is the right shoulder and 2 indicates the left shoulder.
Within this code the body part/site is identified along with other clinical details.
How to use the ICD-10 codes
When a patient’s medical diagnosis has been coded this information can be used in various ways. The code is used in health insurance claims – this way it is identifiable to the insurance company when processing the claim.
The ICD-10 coding system is extremely beneficial in data collection and for researchers who are looking at the spread of disease or its prevalence in various geographical areas, ages, sexes. While research is important for disease control and prevention, insurers might also use the information to forecast future health care costs to countries and governments.
What are CPT Codes?
The acronym CPT stands for Current Procedural Terminology and is widely used by health care professionals, hospitals and insurance companies, just as the ICD-10 codes are. However, while ICD codes explain the diagnoses, a CPT code describes the procedures and services including medical, surgical and diagnostic, that the medical practitioner provides during a visit.
Why are CPT Codes important?
The CPT code is assigned by a coder, who communicates directly with the doctor to have clarity of the specific diagnosis so that accuracy is guaranteed. Getting the CPT code right is imperative as it is the code that will be used to reimburse or pay the patient. Getting the code wrong could mean underpayment or no payment at all.
For example, shoulder labral tears can be investigated by a surgeon using arthroscopy. This is where the surgeon inserts a small fiber-optic camera into the joint through a small incision on the skin. The surgeon can clearly see the joint and use this procedure to help confirm and treat conditions such as labral tears.
Coders must be aware of differences in the types of labral tears and the procedure involved when applying the correct code. Type 1 labral tear (debridement) has the code 29822 whereas type 3 can be a debridement or a SLAP repair therefore going under code number 29807 (Arthroscopy, shoulder, surgical repair of lesion). It is important for the coder to see the medical records and apply the appropriate code which will guarantee the correct payment to the patient.
CPT and ICD codes are necessary for the smooth payment between medical practitioners and insurance companies, giving the patient the ease of mind that their insurance will cover any medical expenses and no money needs to be paid up front.
Please note that information on this page was not authored by Dr. Daniel Grant Schwartz, but was merely painstakingly collected and organized with the characteristic OCD of a surgeon. It has not been proofread (yet) or intended for general public use. Information is intended for internal use only and is only a compilation.