ICD-10 Coding for Bilateral Shoulder Pain(M25.51, M25.52, M75.43, M19.011, M19.012)
Complete ICD-10-CM coding and documentation guide for Bilateral Shoulder Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Bilateral Shoulder Pain
M25.5Primary Range
Pain in joint
Includes codes for unspecified joint pain, including bilateral shoulder pain.
Bursitis of shoulder
Includes codes for specific shoulder conditions like bursitis, which can be bilateral.
Primary osteoarthritis
Used for coding osteoarthritis in shoulders, requiring separate codes for each shoulder.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M25.51 | Pain in right shoulder | Use when pain is specifically localized to the right shoulder. |
|
| M25.52 | Pain in left shoulder | Use when pain is specifically localized to the left shoulder. |
|
| M75.43 | Bursitis of bilateral shoulders | Use when bursitis is confirmed in both shoulders. |
|
| M19.011 | Primary osteoarthritis, right shoulder | Use when osteoarthritis is confirmed in the right shoulder. |
|
| M19.012 | Primary osteoarthritis, left shoulder | Use when osteoarthritis is confirmed in the left shoulder. |
|
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 bilateral shoulder pain
Essential facts and insights about Bilateral Shoulder Pain
Primary ICD-10-CM Codes for bilateral shoulder pain
Decision Criteria
clinical Criteria
- Pain reported and confirmed in the right shoulder
Applicable To
- Right shoulder pain
Excludes
- Pain in left shoulder
- Bilateral shoulder pain
Clinical Validation Requirements
- Patient report of pain localized to the right shoulder
- Physical examination confirming tenderness or pain in the right shoulder
Code-Specific Risks
- Risk of using unspecified codes when laterality is known.
Coding Notes
- Ensure laterality is documented to avoid unspecified codes.
M25.52 - Pain in left shoulder
Use when pain is specifically localized to the left shoulder.
Applicable To
- Left shoulder pain
Excludes
- Pain in right shoulder
- Bilateral shoulder pain
Clinical Validation Requirements
- Patient report of pain localized to the left shoulder
- Physical examination confirming tenderness or pain in the left shoulder
Coding Notes
Ensure laterality is documented to avoid unspecified codes.
M75.43 - Bursitis of bilateral shoulders
Use when bursitis is confirmed in both shoulders.
Applicable To
- Bilateral subacromial bursitis
Excludes
- Unilateral bursitis
Clinical Validation Requirements
- Imaging confirmation of bursitis in both shoulders
- Clinical examination showing signs of bursitis bilaterally
Coding Notes
Document imaging findings to support bilateral diagnosis.
M19.011 - Primary osteoarthritis, right shoulder
Use when osteoarthritis is confirmed in the right shoulder.
Applicable To
- Osteoarthritis in right shoulder
Excludes
- Osteoarthritis in left shoulder
Clinical Validation Requirements
- X-ray or MRI confirming osteoarthritis in the right shoulder
Coding Notes
Document imaging findings for each shoulder separately.
M19.012 - Primary osteoarthritis, left shoulder
Use when osteoarthritis is confirmed in the left shoulder.
Applicable To
- Osteoarthritis in left shoulder
Excludes
- Osteoarthritis in right shoulder
Clinical Validation Requirements
- X-ray or MRI confirming osteoarthritis in the left shoulder
Coding Notes
Document imaging findings for each shoulder separately.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Pain in left shoulder
M25.52Pain in right shoulder
M25.51Primary osteoarthritis, left shoulder
M19.012Primary osteoarthritis, right shoulder
M19.011Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Bilateral Shoulder Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M25.51.
Impact
Clinical: Leads to inaccurate diagnosis and treatment., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Always document laterality in clinical notes.
Impact
Reimbursement: May result in claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Document and code for specific laterality (right, left, bilateral).
Impact
Failure to document laterality can lead to audit findings.
Mitigation Strategy
Implement checklist for documentation to ensure laterality is recorded.
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 Bilateral Shoulder Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Bilateral Shoulder Pain
Use these documentation templates to ensure complete and accurate documentation for Bilateral Shoulder Pain. These templates include all required elements for proper coding and billing.
Orthopedic evaluation for bilateral shoulder pain
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Diagnosis and plan
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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