ICD-10 Coding for Left Shoulder Conditions(M25.512, M75.02, M75.42)
Complete ICD-10-CM coding and documentation guide for Left Shoulder Conditions. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Left Shoulder Conditions
M75Primary Range
Shoulder lesions
Primary range for specific shoulder conditions such as adhesive capsulitis and impingement.
Dislocation and sprain of joints and ligaments of shoulder girdle
Includes traumatic injuries to the shoulder, relevant for coding sprains and dislocations.
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 pain is the primary complaint without a specific underlying condition identified. |
|
| M75.02 | Adhesive capsulitis of left shoulder | Use when there is documented restriction in shoulder movement. |
|
| M75.42 | Impingement syndrome of left shoulder | Use when clinical tests confirm 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 Conditions
Primary ICD-10-CM Codes for left shoulder
Decision Criteria
clinical Criteria
- Pain without specific lesion or injury
Applicable To
- Isolated left shoulder pain
Excludes
- Pain due to specific shoulder lesions (M75.-)
Clinical Validation Requirements
- Patient reports pain localized to the left shoulder
- Physical examination confirms tenderness
Code-Specific Risks
- Risk of undercoding if specific etiology is known but not documented
Coding Notes
- Ensure documentation specifies laterality and absence of specific lesions.
M75.02 - Adhesive capsulitis of left shoulder
Use when there is documented restriction in shoulder movement.
Applicable To
- Frozen shoulder
Excludes
- Shoulder pain without movement restriction (M25.512)
Clinical Validation Requirements
- Documented loss of passive and active range of motion
- Imaging may show capsular thickening
Coding Notes
Document specific ROM limitations and any imaging findings.
M75.42 - Impingement syndrome of left shoulder
Use when clinical tests confirm impingement.
Applicable To
- Subacromial impingement
Excludes
- Adhesive capsulitis (M75.02)
Clinical Validation Requirements
- Positive impingement tests (e.g., Neer, Hawkins-Kennedy)
- Imaging may show subacromial spur
Coding Notes
Ensure documentation includes specific impingement test results.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Impingement syndrome of left shoulder
M75.42Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Left Shoulder Conditions to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M25.512.
Impact
Clinical: Incomplete clinical picture for diagnosis., Regulatory: Potential non-compliance with documentation standards., Financial: May affect reimbursement if specificity is questioned.
Mitigation Strategy
Include imaging results in documentation, Ensure all tests are reported
Impact
Reimbursement: Claims may be denied or delayed., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Always verify and document the affected side as 'left'.
Impact
Risk of audits due to non-specific coding of shoulder conditions.
Mitigation Strategy
Use detailed documentation to support specific ICD-10 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 Conditions, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Left Shoulder Conditions
Use these documentation templates to ensure complete and accurate documentation for Left Shoulder Conditions. These templates include all required elements for proper coding and billing.
Patient with left shoulder pain and limited ROM
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical exam findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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