Rotator cuff injury is a common source of shoulder pain and disability. Accurate ICD-10 coding for rotator cuff injury drives appropriate claim adjudication, supports medical necessity, and reduces audit exposure. For coders, billers, and revenue cycle managers, selecting the correct diagnosis code influences reimbursement, denial risk, and quality measures tied to musculoskeletal care.
This article explains the ICD-10-CM classification for Unspecified rotator cuff tear or rupture, not specified as traumatic, shows when that code is appropriate, presents exclusions and alternatives, and offers practical documentation and billing advice to optimize reimbursement and minimize denials.
The ICD-10-CM Code for Unspecified rotator cuff tear or rupture, not specified as traumatic is M75.100.
Unspecified rotator cuff tear or rupture, not specified as traumatic describes a clinically diagnosed tear of one or more rotator cuff tendons without documentation that the tear resulted from a specific traumatic event, and without specification of laterality or tendon detail. Clinically, rotator cuff injuries range from tendinopathy and partial-thickness tears to full-thickness ruptures involving supraspinatus, infraspinatus, subscapularis, or teres minor. M75.100 is a nontraumatic, unspecified-site designation used when the clinician documents a rotator cuff tear or rupture but does not indicate right versus left shoulder, specific tendon, or whether the tear was traumatic versus degenerative. This code falls under the ICD-10-CM M75 category for shoulder lesions and guides payer determination of medical necessity for conservative care, imaging, or surgical intervention.
The ICD-10-CM Code for Unspecified rotator cuff tear or rupture, not specified as traumatic is M75.100.
Unspecified rotator cuff tear or rupture, not specified as traumatic is used when a clinician documents a rotator cuff tear without noting laterality, traumatic cause, or a more specific rotator cuff diagnosis. Use M75.100 only when documentation lacks details necessary to assign a more specific code (for example, laterality codes or codes specifying partial vs full-thickness tear). The code supports claims for conservative management, diagnostic imaging, and procedural services if clinical notes, exam, and objective testing support medical necessity; however, payers often expect more specific documentation to authorize advanced interventions.
Use M75.100 when a patient presents with new shoulder pain and clinical exam or imaging reports indicate a rotator cuff tear, but the clinician documents no trauma or does not attribute the tear to a specific incident. This is appropriate when notes state "rotator cuff tear" or "rotator cuff rupture" without specifying traumatic mechanism or laterality.
Apply M75.100 for follow-up or initial encounters where the clinician confirms a rotator cuff tear but omits laterality, tendon involved, or whether the tear is partial versus full thickness. When the record lacks the elements required for a more specific M75.10x code, this unspecified code reflects the available documentation.
Select M75.100 for low-complexity visits when the plan is conservative care (physical therapy, NSAIDs, injections) and documentation confirms nontraumatic rotator cuff tear without further specification. Use of the unspecified code here supports claims for conservative services while recognizing the record does not justify a more granular diagnosis.
When historical records or patient report cannot determine which shoulder is affected and the clinician documents the uncertainty, M75.100 is appropriate for accurate reporting without introducing incorrect laterality data.
Do not use M75.100 if the clinician documents a traumatic rotator cuff tear. In that case, use the traumatic rotator cuff tear code (a traumatic code within the M75 series or an external cause code as appropriate) or a more specific traumatic shoulder injury diagnosis. The traumatic mechanism changes coding and may affect payer authorization for imaging and surgery.
If the chart specifies right or left shoulder involvement, do not use the unspecified M75.100. Use the laterality-specific code that corresponds to the documented side (for example, the M75.101/M75.102 family where applicable). Laterality is required by many payers and improves claim accuracy.
If the clinician documents which tendon (for example, supraspinatus) or whether the tear is partial- or full-thickness, assign the more specific ICD-10-CM code that reflects those details rather than M75.100. Specificity reduces denial risk and supports appropriate CPT pairing for procedures.
Do not use M75.100 when the rotator cuff tear is explicitly coded as secondary to another diagnosis (for example, adhesive capsulitis with secondary cuff tear). In such cases, code the primary condition first and sequence the rotator cuff diagnosis per coding conventions.
| Condition | Code | When It Is Used | When It Is Not Used |
|---|---|---|---|
| Unspecified rotator cuff tear or rupture, not specified as traumatic | M75.100 | When rotator cuff tear is documented without laterality, without traumatic mechanism, and without tendon-specific or partial/full-thickness detail | When laterality, traumatic mechanism, tendon specificity, or partial/full-thickness detail is documented |
| Rotator cuff tear or rupture, right shoulder, not specified as traumatic | M75.101 | When clinician documents a nontraumatic rotator cuff tear specifically involving the right shoulder | When laterality is left, unspecified, or the tear is documented as traumatic |
| Rotator cuff tear or rupture, left shoulder, not specified as traumatic | M75.102 | When clinician documents a nontraumatic rotator cuff tear specifically involving the left shoulder | When laterality is right, unspecified, or the tear is documented as traumatic |
| Rotator cuff tear or rupture, specified as traumatic | S46.011A / S46.012A (example traumatic codes) | When the record documents a specific traumatic event causing the rotator cuff tear and initial encounter trauma coding is required | When the tear is nontraumatic or documentation does not link the tear to a specific injury |
Always record right or left shoulder in the assessment and plan. Laterality is a common reason for claim edits and denials; specifying the side allows use of the more specific M75.10x codes and reduces denials.
Clearly state whether the rotator cuff tear is traumatic or degenerative. If trauma is present, document the incident and timing. Mechanism influences code selection and payer review for surgical authorization.
Note which tendon(s) are involved and whether the tear is partial or full thickness when known from imaging or intraoperative findings. Specificity supports clinical necessity for advanced imaging and procedures.
Include imaging reports (MRI, ultrasound) and correlate findings with physical exam (positive impingement tests, weakness, atrophy). Payers look for clinical-imaging concordance to justify higher-level services.
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Coding for rotator cuff injury has direct impact on revenue cycle outcomes:
Accurate ICD-10 coding is critical for healthcare revenue cycle performance. CombineHealth.ai's AI-powered platform helps RCM teams ensure coding accuracy, reduce denials, and optimize reimbursement through intelligent denial management and claim validation. CombineHealth.ai's intelligent platform provides automated claim scrubbing and coding validation to catch errors before submission, reducing denials and improving first-pass acceptance rates.
Q1: What is the ICD-10 code for rotator cuff injury?
The ICD-10-CM code for rotator cuff injury is M75.100 when the clinician documents an Unspecified rotator cuff tear or rupture, not specified as traumatic and the record does not specify laterality, tendon, or traumatic mechanism. Use a more specific code if laterality or traumatic cause is documented.
Q2: When should I use M75.100 vs related codes?
Use M75.100 when documentation lacks laterality, mechanism, or specificity. Use laterality-specific codes (e.g., rotator cuff tear right or left) when the side is recorded. Use traumatic shoulder injury codes when the tear is linked to a specific injury.
Q3: What documentation is required when coding for rotator cuff injury?
Document history of present illness, mechanism of injury (if any), laterality, focused shoulder exam findings, diagnostic imaging results (MRI/ultrasound), treatment plan, and response to conservative therapy. These elements substantiate medical necessity and support the chosen ICD-10 code.
Q4: What are common denial reasons when coding for rotator cuff injury?
Common denials include missing laterality, lack of imaging or conservative treatment documentation when required, mismatched diagnosis-procedure pairings, and insufficient evidence of medical necessity. See our guide on denial management for strategies to address and prevent these denials.