ICD-10-CM Billable Code

M85.411

Solitary bone cyst, right shoulder

Clinical Classification Guidelines

Medical Intelligence & Overview

A solitary bone cyst, also known as a unicameral bone cyst, is a benign (non-cancerous) bone lesion that typically occurs in children and adolescents. When occurring in the right shoulder, it involves a cystic growth within the upper arm bone (humerus). While often asymptomatic, this condition can sometimes lead to pain, swelling, or fracture of the affected bone. Recognizing and understanding this condition is crucial for proper management and treatment.

Causes & Symptoms

Clinical Causes: The exact cause of solitary bone cysts remains unknown. They are believed to result from a build-up of fluid within the bone, possibly due to a developmental abnormality. Some theories suggest they may develop following minor trauma or injury, which leads to fluid accumulation and cyst formation. Genetic factors are also considered, although no specific hereditary link has been identified.

Key Symptoms: Typically no symptoms in many cases. Dull, persistent ache in the shoulder area. Swelling or a noticeable bump in the upper arm or shoulder. Tenderness upon applying pressure. In some cases, a fracture may occur in the weakened bone, causing sudden pain and difficulty moving the shoulder. Limited range of motion, especially if the cyst enlarges or causes discomfort.

Diagnostic & Treatment

Diagnosis Path: Diagnosing a solitary bone cyst involves a combination of clinical evaluation and imaging studies. Healthcare providers may perform the following:

Treatment Protocols: The management of solitary bone cysts varies based on symptoms, size, and risk of fracture. Common approaches 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 M85.411 a billable ICD-10 code?
Yes, M85.411 is a specific, billable code that can be used to indicate a diagnosis for reimbursement purposes.

Documentation

How do I report M85.411?
Clinical documentation must specify the nature of Solitary bone cyst, right shoulder and any associated comorbidities for accurate reporting.

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