ICD-10 Coding for Clavicle Pain(M25.511, S42.022A)
Complete ICD-10-CM coding and documentation guide for Clavicle Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Clavicle Pain
M25.51-M25.59Primary Range
Other joint disorders, not elsewhere classified
Includes shoulder pain codes which are often used for clavicle pain when specific etiology is not identified.
Fracture of clavicle
Specific to clavicle fractures, important for traumatic causes of clavicle pain.
Other acute postprocedural pain
Used for post-surgical pain management related to clavicle procedures.
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 pain is generalized to the right shoulder without specific clavicle injury. |
|
| S42.022A | Displaced fracture of shaft of right clavicle, initial encounter | Use for initial encounter of a displaced midshaft clavicle fracture. |
|
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 clavicle pain
Essential facts and insights about Clavicle Pain
Primary ICD-10-CM Codes for clavicle pain
Decision Criteria
clinical Criteria
- Pain localized to the shoulder area without specific clavicle injury.
Applicable To
- Right shoulder pain
Excludes
- Pain in right sternoclavicular joint (M25.611)
Clinical Validation Requirements
- Physical examination indicating pain localized to the right shoulder area without specific injury.
Code-Specific Risks
- Misclassification if the pain is actually in the clavicle or sternoclavicular joint.
Coding Notes
- Ensure documentation specifies the exact location of pain to avoid misclassification.
S42.022A - Displaced fracture of shaft of right clavicle, initial encounter
Use for initial encounter of a displaced midshaft clavicle fracture.
Applicable To
- Displaced midshaft fracture of right clavicle
Excludes
- Fracture of scapula (S42.1-)
Clinical Validation Requirements
- Radiological evidence of displaced fracture of the clavicle shaft.
Coding Notes
Ensure fracture details are documented, including displacement and location.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Fall, initial encounter
W19.XXXADifferential 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 Clavicle 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: May lead to inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.
Mitigation Strategy
Always specify right or left in documentation.
Impact
Reimbursement: Potential claim denials due to incorrect coding., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Use clavicle-specific codes when the injury is localized to the clavicle.
Impact
Audits may target misclassification of clavicle injuries.
Mitigation Strategy
Ensure detailed documentation of pain location and etiology.
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 Clavicle Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Clavicle Pain
Use these documentation templates to ensure complete and accurate documentation for Clavicle Pain. These templates include all required elements for proper coding and billing.
Emergency Department Visit for Clavicle Injury
Specialty: Emergency MedicineRequired Elements
- Mechanism of injury
- Location and type of pain
- Imaging results
- Neurovascular status
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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