ICD-10-CM Billable Code

M19.011

Primary osteoarthritis, right shoulder

Clinical Classification Guidelines

Medical Intelligence & Overview

Primary osteoarthritis of the right shoulder, classified under ICD-10 code M19.011, is a common joint disorder that affects the cartilage within the shoulder joint. It primarily results from aging and wear and tear over time, leading to pain, stiffness, and decreased mobility. This condition is part of the broader category of osteoarthritis, which can affect various joints, but when localized to the right shoulder without an obvious cause, it is termed primary osteoarthritis.

Causes & Symptoms

Clinical Causes: Natural aging process leading to gradual cartilage deterioration Genetic predisposition affecting cartilage health Repetitive stress or overuse of the shoulder joint, especially in athletes or certain occupations Obesity contributing to increased joint load and degeneration Gender, with women more commonly affected than men Previous injuries or trauma to the shoulder joint that may accelerate cartilage wear

Key Symptoms: Joint pain that worsens with activity or at the end of the day Stiffness in the shoulder, especially after periods of inactivity Reduced range of motion, making certain movements difficult Swelling or tenderness around the joint A grinding or grating sensation during shoulder movement Weakness in the shoulder muscles

Diagnostic & Treatment

Diagnosis Path: Diagnosis typically involves a comprehensive clinical assessment and imaging studies. The healthcare provider will review symptoms and medical history, perform a physical examination to check for tenderness, swelling, and range of motion, and may order imaging tests such as X-rays. These images can reveal joint space narrowing, the presence of osteophytes (bone spurs), and other signs characteristic of osteoarthritis.

Treatment Protocols: While there is no cure for primary osteoarthritis of the shoulder, various management strategies can help relieve symptoms and improve quality of life. These may include:

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.

Clinical Advice & FAQs

Billing Guidance

Is M19.011 a billable ICD-10 code?
Yes, M19.011 is a specific, billable code that can be used to indicate a diagnosis for reimbursement purposes.

Documentation

How do I report M19.011?
Clinical documentation must specify the nature of Primary osteoarthritis, right shoulder and any associated comorbidities for accurate reporting.

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