ICD-10 Coding for Shoulder Pain(M25.511, M25.512)
Complete ICD-10-CM coding and documentation guide for Shoulder Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Shoulder Pain
M25.51-M25.52Primary Range
Pain in joint
This range includes codes for pain in the shoulder joint, specifying laterality.
Shoulder lesions
This range includes specific shoulder conditions like rotator cuff syndrome and impingement.
Sprains and strains of shoulder joint
This range includes codes for traumatic injuries to the shoulder, such as sprains.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M25.511 | Pain in right shoulder | Use when the patient presents with pain specifically in the right shoulder without a more specific diagnosis. |
|
| M25.512 | Pain in left shoulder | Use when the patient presents with pain specifically in the left shoulder without a more specific diagnosis. |
|
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 right shoulder pain
Essential facts and insights about Shoulder Pain
Primary ICD-10-CM Codes for shoulder pain
Decision Criteria
clinical Criteria
- Pain localized to the right shoulder with no other specific diagnosis
Applicable To
- Right shoulder pain
Excludes
- Pain in left shoulder (M25.512)
Clinical Validation Requirements
- Documented pain in right shoulder with ROM assessment
Code-Specific Risks
- Risk of using unspecified codes when laterality is known.
Coding Notes
- Ensure laterality is documented to avoid unspecified codes.
M25.512 - Pain in left shoulder
Use when the patient presents with pain specifically in the left shoulder without a more specific diagnosis.
Applicable To
- Left shoulder pain
Excludes
- Pain in right shoulder (M25.511)
Clinical Validation Requirements
- Documented pain in left shoulder with ROM assessment
Coding Notes
Ensure laterality is documented to avoid unspecified codes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Acute pain due to trauma
G89.11Differential 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 Shoulder Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M25.511.
Impact
Clinical: Inaccurate treatment plans., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Use standardized templates that require laterality., Educate staff on the importance of complete documentation.
Impact
Reimbursement: Claims may be denied or delayed., Compliance: Non-compliance with coding guidelines., Data Quality: Decreased accuracy in health records.
Mitigation Strategy
Document the specific shoulder affected to use the correct code.
Impact
Audits may focus on whether laterality is documented for shoulder pain codes.
Mitigation Strategy
Implement mandatory fields in EHR for laterality.
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 Shoulder Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Shoulder Pain
Use these documentation templates to ensure complete and accurate documentation for Shoulder Pain. These templates include all required elements for proper coding and billing.
General shoulder pain evaluation
Specialty: Primary CareRequired Elements
- Patient history
- Physical examination
- Imaging results if available
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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