ICD-10 Coding for Pain in Left Shoulder(M25.512, M75.42)
Complete ICD-10-CM coding and documentation guide for Pain in Left Shoulder. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pain in Left Shoulder
M25.5Primary Range
Pain in joint
This range includes codes for joint pain, specifically M25.512 for pain in the left shoulder.
Shoulder lesions
This range includes specific shoulder conditions like impingement syndrome and rotator cuff tear, which can cause shoulder pain.
Presence of artificial joint
This range is relevant for documenting the presence of a prosthetic shoulder joint, which may be associated with post-surgical 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 shoulder pain is present without a specific underlying diagnosis. |
|
| M75.42 | Impingement syndrome of left shoulder | Use when impingement is confirmed by clinical tests or imaging. |
|
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 pain in left shoulder
Essential facts and insights about Pain in Left Shoulder
Primary ICD-10-CM Codes for pain left shoulder
Decision Criteria
clinical Criteria
- Pain in the shoulder without specific diagnosis
coding Criteria
- No specific shoulder condition identified
Applicable To
- General shoulder pain without specific diagnosis
Excludes
- Shoulder pain due to specific conditions like rotator cuff tear (M75.1)
Clinical Validation Requirements
- Patient history indicating shoulder pain
- Physical examination showing tenderness or pain on movement
Code-Specific Risks
- Risk of undercoding if a specific condition is identified later
Coding Notes
- Ensure documentation supports the use of a general pain code versus a specific diagnosis.
M75.42 - Impingement syndrome of left shoulder
Use when impingement is confirmed by clinical tests or imaging.
Applicable To
- Subacromial impingement
Excludes
- Rotator cuff tear (M75.1)
Clinical Validation Requirements
- Positive Neer or Hawkins test
- Imaging showing subacromial narrowing
Coding Notes
Ensure clinical tests confirm impingement before coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Presence of left artificial shoulder joint
Z96.612Differential 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 Pain in Left Shoulder 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 or delayed treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims due to insufficient documentation.
Mitigation Strategy
Use templates to ensure comprehensive documentation., Train staff on specific documentation requirements.
Impact
Reimbursement: May result in lower reimbursement if specific condition is not coded., Compliance: Non-compliance with coding guidelines if specific diagnosis is known., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Use specific codes like M75.42 for impingement syndrome when confirmed.
Impact
Audits may target use of general pain codes when specific diagnoses are available.
Mitigation Strategy
Ensure thorough documentation and use of specific codes when possible.
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 Pain in Left Shoulder, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pain in Left Shoulder
Use these documentation templates to ensure complete and accurate documentation for Pain in Left Shoulder. These templates include all required elements for proper coding and billing.
Initial evaluation of shoulder pain
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Pain characteristics
- Functional limitations
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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