Shoulder Muscle, Left ICD-10-PCS Coding & Reimbursement

Summary & Overview

Shoulder Muscle, Left: ICD-10-PCS Procedure Code Group Overview

International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) codes under the group ICD-10 PCS 0K86 cover procedures that cut into left shoulder muscle tissue without draining fluids or gases in order to separate or transect a muscle. Accurate ICD-10-PCS coding for this group is important for precise inpatient procedure documentation, appropriate diagnosis-related group assignment, and correct facility reimbursement.

Shoulder Muscle, LeftICD-10-PCS`ICD-10 PCS 0K86`Inpatient ProcedureProcedure CodingShoulderMusculoskeletalTransectionSoft Tissue

Shoulder Muscle, Left Overview

Procedures in this group involve surgical cutting into or transecting left shoulder muscle tissue to separate or transect the muscle for diagnostic or therapeutic purposes. They target the musculoskeletal and soft tissue components of the shoulder girdle, including rotator cuff and deltoid muscle regions. Accurate coding of these procedures supports correct inpatient classification, impacts diagnosis-related group assignment, and influences facility reimbursement.

Typical Clinical Scenarios

An elderly patient with acute severe left shoulder pain and weakness after a ground-level fall, found on imaging to have a full-thickness tear of the left supraspinatus muscle with retracting muscle fibers causing persistent pain and limited range of motion; the patient is admitted for operative repair to restore shoulder function and relieve pain, requiring cutting into the left shoulder muscle to separate and transect damaged muscle tissue during exposure and repair. Codes: 0K860ZZ, 0K863ZZ
A middle-aged recreational athlete with chronic left rotator cuff degeneration and symptomatic partial-thickness tears that have failed conservative management; admitted for a planned elective open procedure to debride and transect irreparably damaged portions of the left shoulder muscle to prepare for tendon repair and improve long-term function. Codes: 0K863ZZ, 0K864ZZ
A patient with prior left shoulder surgery who presents with persistent pain, scar contracture, and restricted motion months after the index procedure; during inpatient revision surgery the surgeon performs surgical release and partial transection of fibrotic left shoulder muscle tissue to relieve contracture and enable reconstruction. Codes: 0K864ZZ, 0K860ZZ

ICD-10-PCS Codes

ICD-10-PCS codes are seven characters long — each position specifies, in order, the section, body system, root operation, body part, approach, device, and qualifier. Every code in this table shares the same first four characters, meaning they all describe the same root operation on the same body part. The remaining three characters distinguish the approach used, any device placed or maintained, and an additional qualifier.

3 rows

Description
Division of Left Shoulder Muscle, Open Approach
Division of Left Shoulder Muscle, Percutaneous Approach
Division of Left Shoulder Muscle, Percutaneous Endoscopic Approach

DRG Codes

DRG	Description
DRG 040	Peripheral, Cranial Nerve and Other Nervous System Procedures with MCC
DRG 041	Peripheral, Cranial Nerve and Other Nervous System Procedures with CC or Peripheral Neurostimulator
DRG 042	Peripheral, Cranial Nerve and Other Nervous System Procedures without CC/MCC
DRG 500	Soft Tissue Procedures with MCC
DRG 501	Soft Tissue Procedures with CC
DRG 502	Soft Tissue Procedures without CC/MCC
DRG 907	Other O.R. Procedures for Injuries with MCC
DRG 908	Other O.R. Procedures for Injuries with CC
DRG 909	Other O.R. Procedures for Injuries without CC/MCC
DRG 957	Other O.R. Procedures for Multiple Significant Trauma with MCC
DRG 958	Other O.R. Procedures for Multiple Significant Trauma with CC
DRG 959	Other O.R. Procedures for Multiple Significant Trauma without CC/MCC

When a procedure from this group is reported on an inpatient claim, the CMS MS-DRG grouper evaluates the principal diagnosis, procedure codes, and the presence of complicating conditions (CC) or major complicating conditions (MCC) to assign a Diagnosis-Related Group. The DRGs listed above represent the possible MS-DRG assignments for procedures in this group. Each DRG carries a relative weight used to calculate the Medicare inpatient prospective payment.

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ICD-10-PCS Codes

3 rows

Description
Division of Left Shoulder Muscle, Open Approach
Division of Left Shoulder Muscle, Percutaneous Approach
Division of Left Shoulder Muscle, Percutaneous Endoscopic Approach

DRG Codes

DRG	Description
DRG 040	Peripheral, Cranial Nerve and Other Nervous System Procedures with MCC
DRG 041	Peripheral, Cranial Nerve and Other Nervous System Procedures with CC or Peripheral Neurostimulator
DRG 042	Peripheral, Cranial Nerve and Other Nervous System Procedures without CC/MCC
DRG 500	Soft Tissue Procedures with MCC
DRG 501	Soft Tissue Procedures with CC
DRG 502	Soft Tissue Procedures without CC/MCC
DRG 907	Other O.R. Procedures for Injuries with MCC
DRG 908	Other O.R. Procedures for Injuries with CC
DRG 909	Other O.R. Procedures for Injuries without CC/MCC
DRG 957	Other O.R. Procedures for Multiple Significant Trauma with MCC
DRG 958	Other O.R. Procedures for Multiple Significant Trauma with CC
DRG 959	Other O.R. Procedures for Multiple Significant Trauma without CC/MCC