ICD-10 Code M75.122: Complete Rotator Cuff Tear, Left Shoulder

Key Takeaways

ICD-10 Code M75.122 is the billable diagnosis code for a complete non-traumatic rotator cuff tear or rupture of the left shoulder.

Laterality is required: M75.122 specifies the left shoulder only. M75.121 is for the right shoulder, and M75.120 for unspecified side.

Providers must document the tear as non-traumatic in clinical notes to support M75.122. Using this code for a traumatic injury is a common denial trigger.

Pabau’s claims management software helps orthopedic and physical therapy practices track ICD-10 code pairings, reduce submission errors, and document musculoskeletal conditions accurately.

Rotator cuff tears are among the most frequently miscoded musculoskeletal conditions in outpatient orthopedic and physical therapy billing. The wrong laterality code, an absent trauma qualifier, or a missing CPT pairing can push a clean claim into denial within seconds of adjudication. ICD-10 Code M75.122 captures a specific clinical scenario: a complete rotator cuff tear or rupture of the left shoulder that is not specified as traumatic. Getting the documentation right matters not just for reimbursement, but for audit readiness. This reference covers the code definition, classification, sequencing rules, related codes, CPT pairings, and the documentation requirements that payers scrutinize most.

The code is valid for fiscal year 2026 (effective October 1, 2025), confirmed by the CDC/NCHS ICD-10-CM web tool. It sits within Chapter 13 of ICD-10-CM, covering Diseases of the Musculoskeletal System and Connective Tissue (M00-M99). This article covers everything practitioners and coders need to apply M75.122 correctly, from clinical context and laterality rules to crosswalk data and denial prevention.

ICD-10 Code M75.122: Definition and Clinical Description

The full official description for ICD-10 Code M75.122 is: Complete rotator cuff tear or rupture of left shoulder, not specified as traumatic. This means all four components of the diagnosis must be present in provider documentation: the tear is complete (not partial), it involves the rotator cuff, it affects the left shoulder specifically, and there is no documentation identifying an acute traumatic event as the cause.

The rotator cuff is a group of four tendons and their associated muscles surrounding the glenohumeral joint: supraspinatus, infraspinatus, subscapularis, and teres minor. A complete tear means one or more of these tendons has ruptured through its full thickness, severing continuity between muscle and bone attachment. Clinically, this distinguishes it from a partial-thickness tear, which would require a different code.

The “not specified as traumatic” qualifier is where most coding errors originate. This designation applies when the tear develops from degenerative processes, chronic overuse, or repetitive mechanical loading rather than from an identifiable acute injury event. Practices using physical therapy EMR systems benefit from structured templates that prompt clinicians to document mechanism of onset at every encounter.

Code Classification Hierarchy

M75.122 belongs to the following hierarchy within ICD-10-CM:

• Chapter 13: Diseases of the musculoskeletal system and connective tissue (M00-M99)
• Block M70-M79: Other soft tissue disorders
• Category M75: Shoulder lesions
• Subcategory M75.12: Complete rotator cuff tear or rupture, not specified as traumatic
• Code M75.122: Left shoulder (the final character – ‘2’ – specifies laterality for the left shoulder)

This hierarchical placement confirms that M75.122 is a leaf-level billable code. You cannot bill on the parent code M75.12 alone. The CMS ICD-10 codes page publishes the annual tabular list confirming which codes are billable versus non-billable headers.

Laterality Coding: M75.122 vs. M75.121 vs. M75.120

Laterality is a hard requirement under ICD-10-CM. Submitting a claim with the wrong side or with an unspecified-side code when the medical record documents a specific side will trigger payer edits and potential audits. The three codes in the M75.12 family are not interchangeable.

Under HIPAA, covered entities are required to use ICD-10-CM for all diagnosis reporting. Selecting M75.120 when the provider clearly documented the left shoulder in clinical notes is a coding error, not a conservative choice. Payers increasingly flag unspecified codes for additional documentation requests (ADRs) during post-payment audits.

Practices running sports medicine software with structured encounter templates can enforce laterality capture at the point of documentation, preventing downstream coding ambiguity.

Documentation Requirements for M75.122

Payer audits on musculoskeletal codes consistently flag incomplete documentation as the primary cause of recoupment. For M75.122 specifically, the clinical note must support four elements before a coder assigns this diagnosis.

• Side specificity: The provider must state “left shoulder” or equivalent. “Shoulder” alone is insufficient.
• Completeness of tear: Imaging or surgical findings must confirm full-thickness tear, not partial. MRI reports documenting “full-thickness supraspinatus tear” satisfy this requirement. Partial tears route to M75.11x codes.
• Non-traumatic mechanism: The clinical note should state the tear is degenerative, chronic, or of insidious onset. There must be no documentation of a specific acute injury event (fall, collision, forceful overload). If trauma occurred, the coder must evaluate traumatic injury codes from the S-series instead.
• Active clinical relevance: The diagnosis should be contributing to the current encounter’s management or reason for service. Incidental findings coded as primary diagnoses without clinical context are an audit red flag.

Medicare and private payers may also require imaging documentation (MRI preferred, ultrasound accepted by some) before approving surgical procedures coded alongside M75.122. Using digital forms to capture structured clinical intake data helps practices maintain consistent documentation standards across providers.

Associated CPT Procedure Codes

M75.122 is a diagnosis code and cannot be billed alone. It must be paired with a CPT procedure code that reflects what was actually done during the encounter. The procedure selected must be medically necessary given the diagnosis. Three CPT codes pair most commonly with M75.122 in orthopedic and physical therapy settings.

CPT 29827 is the most common pairing for complete tears requiring surgical intervention. The code specifically describes arthroscopic rotator cuff repair, which is the standard of care for most complete non-traumatic tears in patients who fail conservative management. Open repair under CPT 23412 is reserved for revision cases or specific anatomical presentations.

Physical therapy evaluation codes (97161-97163) pair with M75.122 when conservative management is the initial treatment pathway. The complexity level selected should match the documented clinical decision-making and evaluation components, not be assigned by default. Practices using claims management software can build code pairing validation rules that flag mismatched diagnosis-procedure combinations before submission.

Sequencing, Excludes Notes, and Coding Guidelines

ICD-10-CM includes specific instructional notes within the M75 category that govern how M75.122 interacts with other codes. Coders must review these before assigning the code.

Excludes 1 Notes

M75.122 carries Excludes 1 notes for traumatic rotator cuff injuries. This means you cannot assign M75.122 simultaneously with a traumatic rotator cuff tear code from the S-series. Excludes 1 is a hard exclusion: the two conditions cannot coexist in a single encounter according to ICD-10-CM conventions. If the provider documents a traumatic complete rotator cuff tear of the left shoulder, the S40-S49 injury codes apply instead. Practices using physiotherapy compliance requirements frameworks should ensure coders understand this distinction.

Principal vs. Secondary Diagnosis Sequencing

M75.122 may serve as either a principal diagnosis or a secondary code depending on the encounter context. As a principal diagnosis, it drives medical necessity for procedures such as arthroscopic repair or PT evaluation. As a secondary code, it provides clinical context when the primary reason for the encounter is a different condition (for example, a post-surgical follow-up coded primarily with a Z-code).

Per WHO classification standards and CMS official coding guidelines, the code that most accurately reflects the reason for the encounter takes primary position. Listing M75.122 as secondary when it is actually the primary reason for the visit is a sequencing error that can affect payment under DRG or OPPS payment systems.

Bilateral Coding Consideration

When both shoulders have complete non-traumatic rotator cuff tears, coders assign both M75.121 (right) and M75.122 (left). ICD-10-CM does not provide a bilateral code for complete rotator cuff tears within the M75.12 subcategory. Both codes can be reported on the same claim, sequenced according to which side is the primary focus of treatment during that encounter. Orthopedic practices and chiropractic software platforms supporting musculoskeletal practices should be configured to handle multi-code submissions correctly.

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ICD-9-CM Crosswalk for M75.122

Providers managing legacy data or transitioning records from pre-2015 systems may need to map M75.122 back to its ICD-9-CM predecessor. The approximate ICD-9-CM crosswalk equivalent is 727.61 (Complete rupture of rotator cuff).

The crosswalk is approximate because ICD-9-CM 727.61 did not capture laterality. A single ICD-9 code mapped to what are now three separate ICD-10-CM codes (M75.120, M75.121, M75.122). This is a common source of confusion in retrospective data analysis and appeals involving older claims. The AAPC Codify ICD-10-CM lookup tool provides direct crosswalk mapping and is useful when researching historical coding patterns for audit defense or payer appeals.

Practices migrating clinical data into newer clinical documentation workflows should verify that any auto-mapped ICD-10 codes from legacy ICD-9 data are reviewed by a coder, since the laterality split means one-to-one mapping is not accurate.

Common Denial Reasons and How to Avoid Them

Claims containing M75.122 are denied for predictable reasons. Knowing these patterns in advance allows billing staff to build pre-submission edits that catch problems before the claim reaches the payer.

• Traumatic cause documented, non-traumatic code used: If the clinical note mentions a fall, sports injury, or any acute event, M75.122 is incorrect. Payers cross-reference diagnosis codes against encounter notes during post-payment audits. The fix is provider-level education and structured documentation templates that prompt clinicians to state mechanism of onset.
• Unspecified code used when laterality is documented: Assigning M75.120 when the note clearly says “left shoulder” is an avoidable error. Coders should never default to unspecified codes when the record contains the information needed for specificity.
• Missing imaging report in the claim file: Some Medicare Administrative Contractors (MACs) require an MRI or ultrasound report confirming complete tear before approving surgical procedures paired with M75.122. Attach supporting documentation proactively when payer policy requires it.
• CPT-ICD-10 mismatch: Billing a shoulder injection CPT code (e.g., 20610) with M75.122 as the sole diagnosis may generate a medical necessity denial if the payer’s LCD requires documentation of failed conservative therapy before injection approval. Ensure the claim includes any supporting secondary codes (e.g., shoulder pain M25.511) and relevant history.
• Partial-tear code substituted for complete tear: The codes M75.112 (partial tear, left) and M75.122 (complete tear, left) are not interchangeable. Coders must reference imaging or operative reports, not just the ordering diagnosis on the referral.

Practices that configure automated code pairing rules in their physiotherapy clinic management systems reduce these errors at the workflow level rather than catching them after denial.

Related ICD-10 Codes in the M75 Family

M75.122 sits within a broader family of shoulder lesion codes. Accurate coding requires knowing which adjacent code applies when the clinical picture does not match M75.122 exactly.

• M75.0 (Adhesive capsulitis of shoulder): Frozen shoulder. A distinct condition from rotator cuff tear, though both may coexist. Both codes can be assigned if separately documented and clinically active.
• M75.1 (Rotator cuff tear or rupture, not specified as traumatic): The parent category covering unspecified, incomplete, and complete non-traumatic rotator cuff tears, as well as rotator cuff syndrome and supraspinatus tear/syndrome.
• M75.11x (Incomplete rotator cuff tear): Partial-thickness tears. Laterality subcodes follow the same structure (M75.111 right, M75.112 left).
• M75.12x (Complete rotator cuff tear, not traumatic): The parent category for M75.121, M75.122, and M75.120.
• M75.2 (Bicipital tendinitis): Often co-occurring with rotator cuff pathology. Both may be coded if documented.
• M75.3 (Calcific tendinitis of shoulder): Distinct pathology requiring separate documentation and different treatment CPT pairings.
• M25.511 (Pain in right shoulder) / M25.512 (Pain in left shoulder): Secondary symptom codes sometimes appropriate as supporting diagnoses when the primary diagnosis is M75.122.

For practices managing musculoskeletal caseloads across multiple providers, a centralized code reference embedded in physical therapy clinic documentation workflows helps standardize code selection across the team.

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Conclusion

Rotator cuff coding accuracy depends on four things: the right laterality code, a clearly documented non-traumatic mechanism, imaging-supported confirmation of a complete tear, and a procedure code that matches the actual clinical service. ICD-10 Code M75.122 is straightforward when the clinical record is thorough, but it becomes a denial risk the moment any of these elements is absent or ambiguous.

Pabau’s clinical documentation and claims management tools help orthopedic, physical therapy, and sports medicine practices capture the right diagnosis at the point of care, pair it with the appropriate CPT code, and submit clean claims from the start. To see how Pabau supports musculoskeletal coding workflows, book a demo.

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