ICD-10 Coding for Chronic Left Shoulder Pain(M25.512, M75.42)
Complete ICD-10-CM coding and documentation guide for Chronic Left Shoulder Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Chronic Left Shoulder Pain
M25.51-M25.59Primary Range
Other joint disorders, not elsewhere classified
Includes chronic pain conditions of the shoulder when no specific diagnosis is identified.
Shoulder lesions
Includes specific shoulder conditions like rotator cuff tear and adhesive capsulitis.
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 chronic pain is present without a specific diagnosis. |
|
| M75.42 | Left rotator cuff tear or rupture, not specified as traumatic | Use when imaging confirms rotator cuff pathology. |
|
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 chronic left shoulder pain
Essential facts and insights about Chronic Left Shoulder Pain
Primary ICD-10-CM Codes for chronic left shoulder pain
Decision Criteria
clinical Criteria
- Pain persisting beyond 3 months without specific diagnosis.
Applicable To
- Chronic left shoulder pain
Excludes
- Pain in right shoulder (M25.511)
Clinical Validation Requirements
- Documented pain duration over 3 months
- Negative imaging for specific structural damage
Code-Specific Risks
- Risk of undercoding if specific condition is identified but not coded.
Coding Notes
- Ensure documentation specifies chronicity and lack of specific diagnosis.
M75.42 - Left rotator cuff tear or rupture, not specified as traumatic
Use when imaging confirms rotator cuff pathology.
Applicable To
- Partial or complete tear of rotator cuff
Excludes
- Traumatic tear of rotator cuff (S46.01-)
Clinical Validation Requirements
- MRI confirmation of rotator cuff tear
Coding Notes
Ensure imaging supports diagnosis.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Chronic Left Shoulder Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M25.512.
Impact
Clinical: Ambiguity in treatment plans., Regulatory: Non-compliance with ICD-10 requirements., Financial: Potential claim denials due to unspecified laterality.
Mitigation Strategy
Always document left or right shoulder., Use templates that prompt for laterality.
Impact
Reimbursement: Incorrect coding can lead to claim denials., Compliance: Non-compliance with coding specificity requirements., Data Quality: Decreased accuracy in clinical data reporting.
Mitigation Strategy
Use M75.42 when imaging confirms a rotator cuff tear.
Impact
Using non-specific codes when a specific diagnosis is available.
Mitigation Strategy
Regular training on ICD-10 specificity requirements.
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 Chronic Left Shoulder Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Chronic Left Shoulder Pain
Use these documentation templates to ensure complete and accurate documentation for Chronic Left Shoulder Pain. These templates include all required elements for proper coding and billing.
Chronic Left Shoulder Pain Follow-Up
Specialty: OrthopedicsRequired Elements
- Pain duration
- Specific movements causing pain
- Imaging results
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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