2025 ICD-10-CM code Z96.611
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Factors influencing health status and contact with health services - Persons with potential health hazards related to family and personal history and certain conditions influencing health status Chapter 21: Factors influencing health status and contact with health services Feed
Presence of a right artificial shoulder joint.
Modifiers are not directly applicable to Z96.611. However, modifiers might be used in conjunction with any procedure codes billed alongside this diagnosis code.
Medical necessity for coding Z96.611 is typically established by the context of the visit—for example, a routine follow-up after surgery, the diagnosis of a complication related to the prosthesis, or assessment of pain or dysfunction related to the shoulder joint. Documentation must clearly support the medical necessity of the visit.
The clinical responsibility associated with this code depends on the context of the visit.It could involve orthopedic surgeons, rehabilitation specialists, or general practitioners depending on the reason for the patient's encounter with the healthcare system.For example, a post-operative visit would likely involve the orthopedic surgeon, while a routine check-up might be handled by a general practitioner.
- Chapter 21: Factors influencing health status and contact with health services
- Z96.611 falls under the broader category of Z96 (Presence of other functional implants) and specifically within the subcategory of artificial shoulder joints (Z96.61).
In simple words: This code means the patient has a right artificial shoulder joint.The doctor uses this code to show that the patient has a replacement shoulder joint on their right side.
This ICD-10-CM code signifies the presence of a right artificial shoulder joint.It is used to document the existence of a prosthetic shoulder joint in the right shoulder, irrespective of the reason for the encounter. This code is typically used in conjunction with other codes that describe the reason for the visit or any procedures performed.
Example 1: A patient presents for a follow-up appointment after a total shoulder arthroplasty.The surgeon assesses the healing process, range of motion, and overall functional status. Z96.611 is used to indicate the presence of the right artificial shoulder joint., A patient involved in a motor vehicle accident sustains a fracture near the right shoulder joint.During surgery, the existing artificial shoulder joint is also affected. Z96.611 is used in conjunction with codes for the fracture and any necessary repair of the artificial joint. , A patient complains of ongoing pain and stiffness in their right shoulder, six months after undergoing total shoulder arthroplasty. The physician examines the patient and orders X-rays. The presence of the prosthesis is documented using Z96.611, and additional codes are used to describe the patient’s symptoms and any imaging or other procedures ordered.
Documentation should include the date of the original shoulder arthroplasty (if applicable), type of prosthesis implanted, any complications or associated conditions, and the physician's assessment of the patient's current status. Pre-operative and post-operative imaging should also be referenced.
** This code is used to document the presence of the artificial joint and does not inherently indicate the reason for the encounter.Other codes are needed to explain the medical reason for the visit.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Orthopedic surgery, general surgery, rheumatology
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center