Answer: Miscoding either one of these scenarios is a fairly common mistake. Typically, 840.4 (Sprains and strains of shoulder and upper arm, rotator cuff [capsule]) should be used for an acute injury, while 727.61 (Complete rupture of rotator cuff) is used to report a chronic condition. The difference is traumatic versus nontraumatic. Sometimes you may find clues based on the patient’s age and whether it was accident- or sportsrelated.
You should look for supporting documentation to determine if the rotator cuff has suffered a traumatic (840.4) versus non-traumatic (727.61) tear, sprain, strain, or rupture. You’ll see the non-traumatic diagnosis more frequently in older patients.
If you can’t find a definitive diagnosis in the documentation – for example, if the documentation states “rotator cuff syndrome”– use 726.10 (Disorders of bursae and tendons in shoulder region, unspecified).
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