Musculoskeletal condition M65.131 — ICD-10 M65.131

ICD-10: M65.131 | Category: Musculoskeletal Disorders | Billable: Yes

ICD-10 code M65.131 refers to a condition commonly known as trigger finger or stenosing tenosynovitis, which affects the flexor tendons of the fingers. This condition is characterized by the inability to smoothly flex or extend the affected finger, often resulting in a painful "catching" sensation. Trigger finger occurs when the tendon sheath becomes inflamed, leading to narrowing that restricts tendon movement. While it can affect any finger, it is most prevalent in the thumb and ring finger.

The hand consists of numerous intricate structures, including bones, muscles, tendons, and ligaments. The flexor tendons originate in the forearm and run through the carpal tunnel into the fingers. Each tendon is encased in a synovial sheath that facilitates smooth movement. The annular pulleys, particularly A1 and A2 pulleys, are fibrous bands that hold the flexor tendons close to the bones, enabling efficient finger motion.

Biomechanically, the flexor tendons allow for grasping and gripping actions essential for daily activities. The smooth gliding of these tendons through their sheaths is crucial; any disruption can lead to conditions such as trigger finger.

Patient presents with right shoulder pain and swelling after repetitive overhead lifting at work. Upon examination, the physician diagnoses the patient with right shoulder bursitis. Code as M65.131 because the documentation supports the diagnosis of bursitis in the right shoulder, indicating a specific site and type of musculoskeletal condition consistent with the ICD-10-CM guidelines.

To support medical necessity for the code M65.131 and prevent claim denials, key documentation elements include:

1. A clear description of the patient's symptoms, including duration, location, and intensity of pain.
2. Specific details of the physical examination findings, including any tests performed and the results.
3. A definitive diagnosis supported by clinical findings that align with the ICD-10-CM guidelines.
4. Documentation of the treatment plan, including any medications, therapies prescribed, and patient education provided.
5. Evidence of functional limitations or impact on daily activities to establish the necessity for treatment.

Subjective: A 45-year-old female patient presents with complaints of persistent pain and swelling in her right shoulder for the past three weeks. She reports that the pain worsens with overhead activities and is accompanied by stiffness. Objective: On physical examination, the right shoulder exhibits tenderness over the greater tuberosity, mild swelling, and limited range of motion. No crepitus is noted. The patient exhibits a positive Neer and Hawkins-Kennedy test. Assessment: Right shoulder bursitis (ICD-10 Code M65.131). Plan: The patient will be advised to rest the shoulder and apply ice. A course of NSAIDs will be prescribed for pain management. Physical therapy will be initiated to improve range of motion and strengthen the shoulder muscles. Follow-up in four weeks to reassess symptoms.

Several conditions may mimic trigger finger symptoms:

• M65.132 - Trigger Finger, Left Hand
• M65.139 - Trigger Finger, Unspecified
• M65.00 - Tenosynovitis, unspecified site
• M77.10 - Lateral Epicondylitis (Tennis Elbow)
• M77.11 - Medial Epicondylitis (Golfer's Elbow)
• M70.01 - Bursitis of Shoulder
• M75.00 - Rotator Cuff Tear

Differentiating these conditions requires careful assessment of symptom presentation and physical examination findings.

When documenting trigger finger under ICD-10 code M65.131:

1. Include detailed descriptions of symptoms, duration, and functional limitations.
2. Document any treatments attempted (e.g., NSAIDs, splinting).
3. Note response to initial management strategies.

Billing considerations should include:

• Use specific codes for left/right/unspecified as applicable.
• Ensure documentation supports medical necessity for treatments provided.