Facebook tracking pixel
S43.421A
ICD-10-CM
Right Shoulder Supraspinatus Tear Due to Trauma

Find information on right shoulder supraspinatus tear diagnosis, ICD-10 codes (S46.011A, S46.011D, S46.011S), clinical documentation requirements, and treatment options for traumatic rotator cuff tears. Learn about shoulder pain assessment, MRI findings for supraspinatus tears, and surgical vs. non-surgical management of this common shoulder injury. Explore resources for healthcare professionals, including coding guidelines and best practices for accurate diagnosis and documentation of right shoulder supraspinatus tears due to trauma.

Also known as

Traumatic Rotator Cuff Tear
Acute Supraspinatus Tear

Diagnosis Snapshot

Key Facts
  • Definition : Traumatic rip in the supraspinatus shoulder tendon, causing pain and weakness.
  • Clinical Signs : Shoulder pain, weakness with lifting arm, limited range of motion, positive drop arm test.
  • Common Settings : Sports injuries, falls, direct blows to the shoulder, rotator cuff injuries.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC S43.421A Coding
S46

Injury of shoulder and upper arm

Covers injuries to the shoulder, including rotator cuff tears.

M75

Shoulder lesions

Includes rotator cuff syndromes and other shoulder soft tissue disorders.

W00-W19

Falls

If the tear was caused by a fall, this range codes the external cause.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the tear traumatic?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Traumatic Supraspinatus Tear
Rotator Cuff Tear NOS
Shoulder Impingement Syndrome

Documentation Best Practices

Documentation Checklist
  • Document mechanism of trauma: fall, direct blow, etc.
  • Laterality: Specify 'right shoulder' involvement.
  • Supraspinatus tear confirmed by imaging (specify type).
  • Document pain, weakness, range of motion limitations.
  • ICD-10 code: S46.011 Traumatic rupture of right rotator cuff

Coding and Audit Risks

Common Risks
  • Unspecified Trauma Code

    Using unspecified trauma codes like S46.0 without specifying the exact mechanism (e.g., fall, strain) leads to inaccurate data and potential claim denials.

  • Missing Laterality Code

    Failing to document and code the affected side (right) with a laterality code (e.g., M75.111) can cause claim rejections and coding errors.

  • Incomplete Documentation

    Lack of clear documentation specifying the acuteness or chronicity of the tear, partial or full thickness impacts code selection and reimbursement.

Mitigation Tips

Best Practices
  • Document mechanism of trauma for accurate ICD-10 coding (S46.0).
  • CDI: Specify tear size, chronicity, and related symptoms for S46.0 reimbursement.
  • Ensure pre-authorization for MRI/surgery per payer guidelines for compliance.
  • Detailed physical exam findings: Strength, ROM, special tests critical for S46.0.
  • Timely follow-up documentation supports medical necessity for continued treatment.

Clinical Decision Support

Checklist
  • Confirm traumatic injury to right shoulder
  • Pain/weakness with abduction/external rotation
  • Positive Empty Can/Drop Arm test
  • Consider imaging (MRI/Ultrasound)
  • Document injury mechanism and exam findings

Reimbursement and Quality Metrics

Impact Summary
  • ICD-10 S46.011A, CPT 29827 accurate coding maximizes shoulder surgery reimbursement.
  • Timely claim filing, correct modifier use impacts AR days, improves revenue cycle.
  • Surgical quality metrics: Infection rates, readmissions affect hospital value-based payments.
  • Patient-reported outcomes data (PROs) for rotator cuff repair influence reimbursement models.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code S46.011A, S46.011D
  • Verify laterality: Right
  • Document trauma mechanism
  • Check 7th character for initial/subsequent
  • Consider MRI/imaging confirmation

Documentation Templates

Patient presents with complaints of right shoulder pain, weakness, and limited range of motion following a traumatic incident (fall, sports injury, etc.).  Onset of symptoms occurred on [date of onset].  The patient describes the pain as [character of pain: sharp, dull, aching, burning] and located in the anterolateral aspect of the shoulder, possibly radiating to the upper arm.  Pain is exacerbated by overhead activities and abduction.  Physical examination reveals tenderness to palpation over the right supraspinatus tendon insertion, positive Neer and Hawkins-Kennedy impingement tests, and weakness with resisted abduction and external rotation.  Range of motion is restricted in abduction, flexion, and external rotation compared to the contralateral side.  Differential diagnoses include rotator cuff tendinopathy, subacromial bursitis, adhesive capsulitis, and cervical radiculopathy.  Diagnostic imaging (MRI right shoulder) was ordered and confirms a full-thickness tear of the right supraspinatus tendon.  Assessment: Right shoulder supraspinatus tear due to trauma (ICD-10: S46.011A).  Plan: Conservative management with physical therapy focused on range of motion exercises, strengthening, and pain management will be initiated.  Patient education regarding activity modification and proper shoulder mechanics will be provided.  Referral to orthopedic surgery for evaluation and consideration of surgical repair (rotator cuff repair CPT code 29827) will be made if conservative treatment fails to provide adequate relief within [timeframe].  Follow-up appointment scheduled in [timeframe] to assess response to treatment and discuss further management options.
Right Shoulder Supraspinatus Tear Due to Trauma - AI-Powered ICD-10 Documentation