Musculoskeletal condition M65.322 — ICD-10 M65.322

ICD-10: M65.322 | Category: Musculoskeletal Disorders | Billable: Yes

ICD-10 code M65.322 refers to a condition known as trigger finger (stenosing tenosynovitis) affecting the right hand. This musculoskeletal disorder is characterized by the inability to smoothly flex and extend the fingers due to inflammation of the tendons that control finger movement. The condition often presents as a "catching" or "locking" sensation when attempting to move the affected finger, which can lead to pain and discomfort.

Trigger finger commonly occurs in the thumb or ring finger but can affect any digit. It is essential for clinicians to recognize this condition early, as it can significantly impact a patient’s ability to perform daily activities, particularly those requiring fine motor skills.

The anatomy involved in trigger finger includes the flexor tendons, sheaths, and the digital nerves. The flexor tendons run along the palmar side of the hand and are responsible for bending the fingers at the metacarpophalangeal (MCP) and interphalangeal joints. Each tendon is surrounded by a synovial sheath that allows smooth gliding during finger movement.

Biomechanically, when a finger flexes, the flexor tendon slides through the fibrous pulleys located at various points along the finger. These pulleys maintain tendon position and prevent bowstringing. Trigger finger occurs when there is inflammation of the tendon sheath or thickening of the pulley, leading to restricted movement and potential locking of the tendon.

Patient presents with right shoulder pain and swelling after a recent increase in physical activity, specifically overhead lifting during work. Upon examination, tenderness is noted over the subacromial bursa, with limited range of motion. Code as M65.322 because this code specifically captures the diagnosis of bursitis affecting the right shoulder, reflecting the patient's symptoms and the clinical findings.

To support medical necessity for ICD-10 code M65.322 and prevent claim denials, the following documentation elements should be included:

• Detailed History: Document the onset, duration, and nature of symptoms, including any exacerbating factors.
• Physical Examination Findings: Clearly note the findings from the physical exam, particularly signs of tenderness, swelling, or range of motion limitations specifically related to the shoulder.
• Assessment and Diagnosis: Provide a clear diagnosis that correlates with the patient's symptoms and examination findings, linking it to the specific ICD-10 code.
• Treatment Plan: Outline the treatment plan, including any prescribed medications, referrals, or recommended therapies, demonstrating the medical necessity of the interventions.
• Follow-Up Documentation: Record any follow-up assessments or changes in the patient's condition to support ongoing treatment and management of the condition.

Subjective: A 45-year-old female patient reports a 2-week history of increasing pain in her right shoulder, especially when reaching overhead or lifting objects. She denies any previous shoulder injuries but mentions a recent increase in her activity level due to home renovations. Objective: Physical examination reveals tenderness over the anterior shoulder, with positive Neer and Hawkins tests. Active range of motion is limited in abduction and flexion due to pain. No signs of joint instability are noted. Assessment: Right shoulder bursitis (ICD-10 code M65.322). The patient’s symptoms and examination findings are consistent with inflammation of the bursa in the shoulder joint, likely exacerbated by recent increased physical activity. Plan: Recommend rest and activity modification to prevent further irritation. Prescribe NSAIDs for pain control and inflammation. Refer for physical therapy to focus on stretching and strengthening exercises. Follow-up in four weeks or sooner if symptoms worsen.

Several conditions may mimic trigger finger symptoms; these include:

• M65.321: Trigger Finger, Left Hand
• M66.00: Spontaneous Rupture of Flexor Tendon
• M75.00: Rotator Cuff Syndrome
• M79.646: Pain in Limb (non-specific)
• M65.39: Other Specified Disorders of Synovium and Tendon Sheath

Differentiating these conditions requires careful assessment of symptoms, history, and physical examination findings.

Accurate documentation is crucial for billing purposes under ICD-10 code M65.322:

1. Clearly document patient history, including symptom onset and severity.
2. Record findings from physical examinations thoroughly.
3. Include details regarding conservative management strategies attempted.
4. If surgical intervention occurs, ensure documentation reflects procedural codes accurately.

Utilizing templates within EMR systems can streamline this process while ensuring compliance with coding guidelines.