ICD-10 Coding for Unspecified Shoulder Pain(M25.519)
Complete ICD-10-CM coding and documentation guide for Unspecified Shoulder Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Unspecified Shoulder Pain
M25.50-M25.59Primary Range
Other joint disorders, not elsewhere classified
This range includes codes for joint disorders, including unspecified shoulder pain.
Key Information: ICD-10 code for unspecified shoulder pain
Essential facts and insights about Unspecified Shoulder Pain
Primary ICD-10-CM Code for shoulder pain unspecified
Decision Criteria
clinical Criteria
- Pain without specific etiology and no laterality documented.
documentation Criteria
- Negative imaging results for structural damage.
Applicable To
- Shoulder pain NOS
Clinical Validation Requirements
- Tenderness on palpation
- Limited range of motion
- Negative imaging for fracture or dislocation
Code-Specific Risks
- Using when laterality is documented
- Failing to document negative imaging
Coding Notes
- Ensure no laterality is documented when using M25.519.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Unspecified shoulder lesion
M75.9Differential 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 Unspecified Shoulder Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M25.519.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Ensure imaging results are included in the documentation., Review documentation for completeness before coding.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records.
Mitigation Strategy
Use M25.511 for right shoulder pain or M25.512 for left shoulder pain.
Impact
High audit risk if laterality is documented but unspecified code is used.
Mitigation Strategy
Ensure documentation supports the use of unspecified 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 Unspecified Shoulder Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Unspecified Shoulder Pain
Use these documentation templates to ensure complete and accurate documentation for Unspecified Shoulder Pain. These templates include all required elements for proper coding and billing.
Orthopedic Clinic Visit
Specialty: OrthopedicsRequired Elements
- Subjective: Patient's description of pain
- Objective: Physical exam findings
- Assessment: Diagnosis and differential
- Plan: Treatment and follow-up
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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