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

 

 

 

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

99201-99205 Office New
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.