M19.01 ICD-10-CM Code: Primary osteoarthritis, shoulder

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for M19.01 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on M19.01 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for M19.01

MedCoder structured workflow — derived from this code’s own official record

Before you code M19.01

1. M19.01 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

   ReviewM19.011, M19.012, M19.019

   See the relationships section · Guide: How to choose an ICD-10-CM code →

2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with M19.01. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

   See the official tabular notes

Choose the right path

1. Does the documentation support one of the more specific codes beneath M19.01?
   Yes → Select that code and continue the checks below on its own page.
   No → M19.01 cannot be reported as written; query for the specificity its subcategory needs.

   ReviewM19.011, M19.012, M19.019

2. Does the documentation support a condition named in M19.01’s Excludes1 note?
   Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
   No → Continue.

   ReviewM15

Consider M19.01. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Official instructions as workflow

• Excludes1 — check before selecting M19.01(1 note)

  Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with M19.01: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

  CompareM15

  See the official tabular notes · Guidelines I.A.12.a

• Excludes2 — not part of M19.01(3 notes)

  Coding workflow: The conditions named in this note are not included in M19.01. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareM47, M20.2

  See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse M19.01 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of M19.01 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• M15— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of polyarthritis moves the case to M15; the two are not reported together unless documented as unrelated.

  Full comparison: M19.01 vs M15 →

• M47— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of arthrosis of spine adds M47; it is not part of this code and both may be reported when both are documented.

  Full comparison: M19.01 vs M47 →

• M20.2— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of hallux rigidus adds M20.2; it is not part of this code and both may be reported when both are documented.

  Full comparison: M19.01 vs M20.2 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Verify Before Coding

• Not billable as written — a more specific code is required: M19.011, M19.012, M19.019.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name M19.01 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 3 Excludes1 notes: M12 — Other and unspecified arthropathy (via M19.-), M13 — Other arthritis (via M19.-), M15 — Polyosteoarthritis (via M19.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Related Codes

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Osteoarthritis”; these codes share that main term but sit in a different category of the Tabular List.

M16.3 — Unilateral osteoarthritis resulting from hip dysplasia (hip, due to hip dysplasia), M16.4 — Bilateral post-traumatic osteoarthritis of hip (hip, bilateral, post-traumatic), M16.5 — Unilateral post-traumatic osteoarthritis of hip (post-traumatic NEC, hip), M16.6 — Other bilateral secondary osteoarthritis of hip (secondary, hip, bilateral), M16.7 — Other unilateral secondary osteoarthritis of hip (secondary, hip), M16.9 — Osteoarthritis of hip, unspecified (hip), M17.0 — Bilateral primary osteoarthritis of knee (knee, bilateral), M17.1 — Unilateral primary osteoarthritis of knee (knee, primary), M17.2 — Bilateral post-traumatic osteoarthritis of knee (knee, bilateral, post-traumatic), M17.3 — Unilateral post-traumatic osteoarthritis of knee (post-traumatic NEC, knee), M17.4 — Other bilateral secondary osteoarthritis of knee (secondary, knee, bilateral), M17.5 — Other unilateral secondary osteoarthritis of knee (secondary, knee), M17.9 — Osteoarthritis of knee, unspecified (knee), M18.0 — Bilateral primary osteoarthritis of first carpometacarpal joints (primary, hand joint, first carpometacarpal joint, bilateral), M18.1 — Unilateral primary osteoarthritis of first carpometacarpal joint (primary, hand joint, first carpometacarpal joint), M18.2 — Bilateral post-traumatic osteoarthritis of first carpometacarpal joints (post-traumatic NEC, hand joint, first carpometacarpal joint, bilateral), M18.3 — Unilateral post-traumatic osteoarthritis of first carpometacarpal joint (post-traumatic NEC, hand joint, first carpometacarpal joint), M18.4 — Other bilateral secondary osteoarthritis of first carpometacarpal joints (secondary, hand joint, first carpometacarpal joint, bilateral), M18.5 — Other unilateral secondary osteoarthritis of first carpometacarpal joint (secondary, hand joint, first carpometacarpal joint), M18.9 — Osteoarthritis of first carpometacarpal joint, unspecified (hand joint, first carpometacarpal joint), +10 more

Contextual Map

Every relationship of M19.01 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run M19.01 with these 3 related codes in Claim Check

Hierarchy

• M00-M99 — Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) (M00-M99)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• M00-M25 — Arthropathies[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• M15-M19 — Osteoarthritis[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes1 notes

• M12 — Other and unspecified arthropathy[Excludes1](via M19.-): “arthrosis (M15-M19)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• M13 — Other arthritis[Excludes1](via M19.-): “arthrosis (M15-M19)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• M15 — Polyosteoarthritis[Excludes1](via M19.-): “bilateral involvement of single joint (M16-M19)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Nearest codes (40)

• M19 — Other and unspecified osteoarthritis[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• M19.0 — Primary osteoarthritis of other joints[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• M19.011 — Primary osteoarthritis, right shoulder[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• M19.012 — Primary osteoarthritis, left shoulder[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• M19.019 — Primary osteoarthritis, unspecified shoulder[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• M19.02 — Primary osteoarthritis, elbow[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• M19.021 — Primary osteoarthritis, right elbow[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• M19.022 — Primary osteoarthritis, left elbow[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 32 more

Change history

• FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Common coding questions

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to M19.01 in its code family, with their registry titles.

• M19 — Other and unspecified osteoarthritis
• M19.0 — Primary osteoarthritis of other joints
• M19.011 — Primary osteoarthritis, right shoulder
• M19.012 — Primary osteoarthritis, left shoulder
• M19.019 — Primary osteoarthritis, unspecified shoulder
• M19.02 — Primary osteoarthritis, elbow
• M19.021 — Primary osteoarthritis, right elbow
• M19.022 — Primary osteoarthritis, left elbow
• M19.029 — Primary osteoarthritis, unspecified elbow
• M19.03 — Primary osteoarthritis, wrist

View all codes in the M19 family