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M75.100
ICD-10-CM
Supraspinatus Tear

Find information on Supraspinatus Tear diagnosis including ICD-10 code M75.11, clinical documentation requirements, rotator cuff injury symptoms, shoulder pain treatment, MRI findings for Supraspinatus Tendinopathy, and effective physical therapy exercises. Learn about Supraspinatus Tear repair surgery, postoperative care, and common healthcare coding guidelines for accurate medical billing. This resource provides valuable insights for physicians, coders, and patients seeking information on Supraspinatus Tear diagnosis and management.

Also known as

Rotator Cuff Tear
Shoulder Tendon Tear

Related ICD-10 Code Ranges

Complete code families applicable to AAPC M75.100 Coding
S46.0-

Rotator cuff tear or rupture

Injury to the rotator cuff muscles or tendons in the shoulder.

M75.1-

Rotator cuff syndromes

Pain and limited movement due to shoulder impingement or tendinitis.

S46.-

Injuries to the shoulder and upper arm

Includes various injuries like fractures, dislocations, and sprains.

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
Supraspinatus tendon tear
Rotator cuff tear
Adhesive capsulitis

Documentation Best Practices

Documentation Checklist
  • Supraspinatus tear diagnosis documented
  • Laterality (left or right shoulder) specified
  • Mechanism of injury/onset documented
  • Symptoms (pain, weakness, ROM) detailed
  • Physical exam findings (e.g., impingement tests)

Coding and Audit Risks

Common Risks
  • Unspecified Laterality

    Coding a supraspinatus tear without specifying right, left, or bilateral can lead to claim denials and inaccurate data reporting. Use ICD-10 laterality codes.

  • Incomplete Documentation

    Lack of sufficient documentation specifying the type of tear (full-thickness, partial-thickness) impacts accurate code assignment and reimbursement.

  • Traumatic vs. Atraumatic

    Failing to distinguish between a traumatic tear (S46) and an atraumatic/degenerative tear (M75.1) leads to coding errors and impacts quality metrics.

Mitigation Tips

Best Practices
  • Accurate ICD-10 coding (S46.0-, M75.1-) for Supraspinatus Tear diagnoses.
  • Detailed HPI documentation, including mechanism of injury and pain levels.
  • Conduct thorough physical exam, noting ROM limitations, weakness, palpation tenderness.
  • Correlate imaging (MRI, ultrasound) findings with clinical presentation for specificity.
  • Ensure CDI aligns documentation with coding for appropriate reimbursement and compliance.

Clinical Decision Support

Checklist
  • 1. Painful arc test positive? (ICD-10 M75.1)
  • 2. Drop-arm test positive? Document abduction weakness. (SNOMED CT 246434006)
  • 3. Empty/full can test result? Assess supraspinatus strength. (CPT 99204)
  • 4. Imaging (MRI/Ultrasound) confirms tear? Document dimensions, location. (CPT 73221)

Reimbursement and Quality Metrics

Impact Summary
  • **Reimbursement and Quality Metrics Impact Summary: Supraspinatus Tear**
  • **Keywords:** Supraspinatus tear, ICD-10 M75.1, CPT 29827, rotator cuff repair, shoulder arthroscopy, medical billing, coding accuracy, reimbursement rates, hospital quality reporting, value-based care, patient outcomes
  • **Impact 1:** Accurate coding (M75.1, relevant CPT) maximizes reimbursement.
  • **Impact 2:** Proper documentation impacts quality metrics for surgical outcomes.
  • **Impact 3:** Time to surgery influences quality scores and patient satisfaction.
  • **Impact 4:** Post-op physical therapy compliance affects functional recovery reporting.

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 M75.11 for right, M75.12 for left
  • Document abduction weakness
  • Specify partial/full thickness
  • Include imaging findings MRI/ultrasound
  • Confirm tear cause traumatic/degenerative

Documentation Templates

Patient presents with complaints of shoulder pain, consistent with a suspected supraspinatus tear.  Symptoms include pain localized to the lateral aspect of the shoulder, exacerbated by abduction and external rotation.  Onset of pain was gradual or acute, potentially related to a specific injury or repetitive overhead activities.  Pain intensity is reported as mild, moderate, or severe, impacting activities of daily living such as reaching, lifting, and sleeping.  Physical examination reveals tenderness to palpation over the greater tuberosity, positive Neer and Hawkins-Kennedy impingement tests, and limited active range of motion.  Strength testing may demonstrate weakness in abduction and external rotation.  Differential diagnosis includes rotator cuff tendinopathy, subacromial bursitis, adhesive capsulitis, and cervical radiculopathy.  Diagnostic imaging, such as an MRI or ultrasound, is ordered to confirm the diagnosis of supraspinatus tear and assess the degree of tearing, including partial-thickness tear, full-thickness tear, or massive rotator cuff tear.  Treatment plan may include conservative management with rest, ice, compression, elevation, physical therapy focusing on range of motion and rotator cuff strengthening exercises, and nonsteroidal anti-inflammatory drugs (NSAIDs).  Corticosteroid injections may be considered for pain management.  Surgical intervention, such as arthroscopic rotator cuff repair, may be indicated for full-thickness tears, failed conservative management, or significant functional limitations.  Patient education provided regarding activity modification, proper body mechanics, and expected recovery time.  Follow-up appointment scheduled to assess treatment response and adjust plan as needed.  ICD-10 code M75.11 (Rotator cuff tear or rupture, right shoulder) or M75.12 (Rotator cuff tear or rupture, left shoulder) will be used, with additional codes as appropriate to reflect the specific findings and treatment provided.  CPT codes will be determined based on the procedures performed, such as injection, aspiration, or surgical repair.