ICD-10 Coding for Left Shoulder Pain(M25.512, M75.42)
Complete ICD-10-CM coding and documentation guide for Left Shoulder Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Left Shoulder Pain
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M25.512 | Pain in left shoulder | Use when no specific underlying cause is identified for the shoulder pain. |
|
| M75.42 | Impingement syndrome of shoulder | Use when clinical tests and imaging confirm shoulder impingement. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for left shoulder pain
Essential facts and insights about Left Shoulder Pain
Primary ICD-10-CM Codes for left shoulder pain
Decision Criteria
clinical Criteria
- Pain present without specific diagnosis
coding Criteria
- No specific injury or condition identified
documentation Criteria
- Detailed history and physical exam findings documented
Applicable To
- General shoulder pain without specific diagnosis
Clinical Validation Requirements
- Patient history indicating pain duration and location
- Physical exam findings such as limited range of motion
Code-Specific Risks
- Risk of undercoding if a specific diagnosis is available
Coding Notes
- Ensure documentation supports the use of a general pain code when no specific diagnosis is confirmed.
M75.42 - Impingement syndrome of shoulder
Use when clinical tests and imaging confirm shoulder impingement.
Applicable To
- Shoulder impingement confirmed by clinical tests
Excludes
- Rotator cuff tear (S46.0)
Clinical Validation Requirements
- Positive Neer or Hawkins test
- Imaging confirming impingement
Coding Notes
Ensure clinical tests are documented to support this diagnosis.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Presence of artificial shoulder joint
Z96.612Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Impingement syndrome of shoulder
M75.42Strain of muscle(s) and tendon(s) of the rotator cuff of left shoulder, initial encounter
S46.012APain in left shoulder
M25.512Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Left Shoulder Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M25.512.
Impact
Clinical: May lead to misdiagnosis., Regulatory: Increases risk of audit., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Ensure thorough documentation of clinical findings., Use specific codes when possible.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audit due to lack of specificity., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Use specific codes like M75.42 for impingement when confirmed.
Impact
Increased audit risk when using general codes without supporting documentation.
Mitigation Strategy
Ensure documentation supports the use of specific codes.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Left Shoulder Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Left Shoulder Pain
Use these documentation templates to ensure complete and accurate documentation for Left Shoulder Pain. These templates include all required elements for proper coding and billing.
Patient with non-specific shoulder pain
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical exam
- Diagnostic tests
- Assessment
- Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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