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S43.439A
ICD-10-CM
Shoulder Labrum Tear

Find information on shoulder labrum tear diagnosis, including clinical documentation requirements, medical coding (ICD-10, CPT), and healthcare resources. Learn about SLAP tears, Bankart lesions, labral tear symptoms, and diagnostic tests like MRI arthrogram. This resource provides guidance for accurate medical coding and comprehensive clinical documentation of shoulder labrum tears for healthcare professionals.

Also known as

SLAP Lesion
Bankart Lesion
Glenoid Labrum Tear

Diagnosis Snapshot

Key Facts
  • Definition : Rip in the shoulder cartilage ring, causing instability and pain.
  • Clinical Signs : Shoulder pain, clicking, popping, catching, weakness, limited motion.
  • Common Settings : Sports injuries, falls, repetitive overhead motions, weightlifting.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC S43.439A Coding
S43.4-

Dislocation of shoulder

Includes superior labrum anterior-posterior (SLAP) tears.

M24.4-

Internal derangement of joint

Covers unspecified shoulder internal derangements which can include labral tears.

S43.8-

Other injuries to shoulder

Can be used for labral tears not classified elsewhere.

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
Shoulder Labrum Tear
Rotator Cuff Tear
Shoulder Impingement

Documentation Best Practices

Documentation Checklist
  • Document mechanism of injury (traumatic vs. atraumatic)
  • Specify location of tear (anterior, posterior, superior)
  • Describe associated injuries (rotator cuff, biceps tendon)
  • Include physical exam findings (e.g., apprehension test)
  • Imaging results confirming diagnosis (MRI, CT arthrogram)

Coding and Audit Risks

Common Risks
  • Unspecified Laterality

    Coding labrum tear without specifying right, left, or bilateral shoulder leads to claim rejections and inaccurate data.

  • Missing Traumatic Cause

    Failure to document traumatic vs. atraumatic tear impacts code selection and appropriate treatment coding like surgery.

  • Incomplete Documentation

    Lack of specific tear type (SLAP, Bankart) details hinders accurate coding, affecting reimbursement and quality metrics.

Mitigation Tips

Best Practices
  • Thorough HPI, accurate ICD-10 (S43.4-), optimize reimbursement.
  • Detailed PE, document tear type/location for correct CPT coding.
  • Image studies (MRI) correlation, CDI for SLAP vs Bankart lesions.
  • Pre-op & post-op notes, compliant with payer guidelines, avoid denials.
  • Timely documentation, clear communication for optimal patient care.

Clinical Decision Support

Checklist
  • Verify positive OBrien's or Apprehension test
  • Confirm limited ROM and pain with abduction
  • Check for clicking, popping, or grinding sensation
  • Document history of trauma or repetitive motion
  • Correlate imaging (MRI/CT arthrogram) with symptoms

Reimbursement and Quality Metrics

Impact Summary
  • Shoulder Labrum Tear reimbursement hinges on accurate coding (CPT 29806, 29807) and modifier use for optimal payment.
  • Coding errors for labrum tear diagnosis (ICD-10 S43.4--) impact hospital case mix index and quality reporting.
  • Proper documentation of labrum tear severity and type influences reimbursement and quality metric calculations.
  • Timely filing and appeals for labrum tear claims maximize reimbursement and minimize revenue cycle delays.

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 labrum tear location
  • Document tear type/size
  • ICD-10 S43.4, M75.1
  • MRI confirms diagnosis
  • Consider 7th character

Documentation Templates

Patient presents with complaints of shoulder pain, instability, clicking, catching, or popping sensation in the shoulder joint.  Onset of symptoms reported as [acute/gradual/insidious] and related to [specific injury/repetitive motion/unknown cause].  Patient describes pain as [sharp/dull/aching/burning] and located in the [anterior/posterior/lateral] aspect of the shoulder, potentially radiating to the [neck/upper arm/forearm].  Pain is [aggravated/alleviated] by [specific movements/activities/rest].  Physical examination reveals [positive/negative] apprehension test, [positive/negative] relocation test, and [positive/negative] O'Brien's test.  Range of motion in the affected shoulder is [limited/normal] in [flexion/extension/abduction/internal rotation/external rotation] compared to the contralateral side.  Palpation reveals [tenderness/crepitus] over the [anterior/posterior/lateral] aspect of the shoulder joint.  Suspected shoulder labrum tear, likely [SLAP tear/Bankart lesion] based on mechanism of injury and clinical presentation.  Differential diagnosis includes rotator cuff tear, shoulder impingement syndrome, biceps tendinopathy, and osteoarthritis.  Ordered MRI arthrogram of the shoulder for definitive diagnosis.  Treatment plan includes conservative management with physical therapy focusing on strengthening and stabilizing the shoulder girdle.  Patient education provided on activity modification and pain management strategies.  Surgical intervention, such as arthroscopic labral repair, will be considered if conservative treatment fails to provide adequate symptom relief.  Follow-up scheduled in [timeframe] to assess response to treatment.  ICD-10 code: [appropriate ICD-10 code, e.g., S43.431A for traumatic anterior labrum tear, right shoulder, initial encounter].  CPT codes for evaluation and management, imaging, and procedures will be documented accordingly.