Facebook tracking pixel
M75.100
ICD-10-CM
Rotator Cuff Rupture

Find information on Rotator Cuff Rupture diagnosis including ICD-10 codes (M75.111, M75.112, M75.121, M75.122), clinical documentation requirements, differential diagnosis considerations, and common treatment options. Learn about rotator cuff tear symptoms, physical exam findings for rotator cuff injury, surgical repair, and post-operative care. This resource provides guidance on accurate medical coding and complete healthcare documentation for rotator cuff tears.

Also known as

Rotator Cuff Tear
Shoulder Tendon Tear

Diagnosis Snapshot

Key Facts
  • Definition : Tear in the shoulder muscles and tendons, causing pain and limited movement.
  • Clinical Signs : Shoulder pain, weakness, stiffness, clicking or popping sensation, difficulty sleeping on affected side.
  • Common Settings : Sports injuries, falls, repetitive overhead activities, age-related degeneration.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC M75.100 Coding
M75.1-

Rotator cuff syndromes

Includes tears and tendinitis of rotator cuff muscles.

S46.-

Injury of shoulder and upper arm

Covers various shoulder injuries, including rotator cuff tears from trauma.

M25.5-

Pain in shoulder

Can be used for pain associated with a rotator cuff tear if the tear itself isn't the focus.

Code-Specific Guidance

Decision Tree for

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

Is the rotator cuff rupture traumatic?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Rotator cuff tear
Shoulder impingement
Biceps tendinitis

Documentation Best Practices

Documentation Checklist
  • Rotator cuff rupture: Document laterality, tear size, & chronicity.
  • ICD-10 M75.1-: Specify partial/full thickness, traumatic/degenerative.
  • CPT 23410-29828: Document arthroscopic/open, debridement/repair.
  • Pain, weakness, limited ROM: Specific movements, impact on ADLs.
  • Pre-op & post-op diagnosis: Include if different, e.g., impingement.

Coding and Audit Risks

Common Risks
  • Unspecified laterality

    Coding rotator cuff rupture without specifying right, left, or bilateral shoulder can lead to claim denials and inaccurate reporting. Use specific laterality codes.

  • Missing acuity documentation

    Incomplete documentation of acute vs. chronic rupture impacts code selection and reimbursement. CDI should query physicians for clarification.

  • Traumatic vs. Atraumatic

    Distinguishing traumatic ruptures from degenerative ones is crucial for accurate coding and affects injury-related statistics. Ensure proper documentation.

Mitigation Tips

Best Practices
  • Document precise tear size, location for ICD-10 accuracy (S46.0).
  • Code injury mechanism, chronicity for proper reimbursement (717.0).
  • MRI, arthrogram reports must support rupture diagnosis, not tendinopathy.
  • Evaluate, document conservative treatment attempts prior to surgery coding.
  • Clearly record functional limitations for optimal MCO approval, compliance.

Clinical Decision Support

Checklist
  • Confirm pain/weakness shoulder abduction/external rotation
  • Document Neer and Hawkins tests results
  • Order/review MRI shoulder for tendon tear confirmation
  • Assess functional impact/limitations ADLs
  • Consider surgical consult if indicated

Reimbursement and Quality Metrics

Impact Summary
  • Rotator Cuff Rupture Reimbursement: Coding accuracy impacts payer contracts and medical billing revenue cycle.
  • Quality Metrics Impact: Accurate ICD-10 (S46, M75) and CPT (23410-29999) coding affects hospital reporting and value-based care.
  • Denial Management: Proper documentation of rupture type (full/partial), acuity, and laterality crucial for claim approvals.
  • Rotator Cuff Repair Coding: Modifier -50 (bilateral) or -LT/-RT impacts reimbursement and quality data on surgical interventions.

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 tear size/location
  • Document abduction/external rotation weakness
  • Specify full/partial tear
  • ICD-10 M75.1xx, S46.0xx
  • Confirm MRI/arthroscopy findings

Documentation Templates

Patient presents with complaints of shoulder pain, consistent with symptoms of a rotator cuff tear.  Onset of pain was [Onset - e.g., gradual, sudden], [Duration - e.g., 2 weeks, 3 months] ago,  described as [Pain Quality - e.g., sharp, dull, aching] and located [Pain Location - e.g., anterior shoulder, lateral shoulder, radiating down the arm].  Pain is aggravated by [Aggravating Factors - e.g., overhead activities, lifting, sleeping on affected side] and relieved by [Relieving Factors - e.g., rest, ice, over-the-counter pain medication]. Patient reports [Degree of Functional Limitation - e.g., difficulty with dressing, reaching overhead, lifting objects].  Physical examination reveals [Positive Findings - e.g., tenderness to palpation over the affected shoulder, limited range of motion, positive Neer impingement sign, positive Hawkins-Kennedy test, weakness with external rotation and abduction].  Differential diagnosis includes rotator cuff tendinopathy, shoulder impingement syndrome, adhesive capsulitis, and cervical radiculopathy.  Preliminary diagnosis of rotator cuff rupture is suspected based on clinical presentation and physical exam findings.  Ordered [Imaging Studies - e.g., shoulder x-ray, MRI of the shoulder] to confirm the diagnosis and assess the extent of the tear.  Treatment plan includes [Conservative Management - e.g., rest, ice, NSAIDs, physical therapy referral] or [Surgical Options - e.g., rotator cuff repair] depending on imaging results and patient's response to conservative management.  ICD-10 code [Appropriate ICD-10 code - e.g., M75.111, M75.112, S46.001A, S46.001D] is considered.  Patient education provided regarding rotator cuff injury, recovery expectations, and potential complications.  Follow-up appointment scheduled in [Duration - e.g., 2 weeks, 4 weeks] to review imaging results and discuss further management.