ICD-10 Coding for Right Shoulder Pain(M25.511, M75.111)
Complete ICD-10-CM coding and documentation guide for Right Shoulder Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Shoulder Pain
M25.5Primary Range
Pain in joint
This range includes codes for joint pain, including unspecified shoulder pain.
Rotator cuff syndrome
This range includes codes for rotator cuff disorders, which may cause shoulder pain.
Sprain and strain of shoulder joint
This range includes codes for traumatic injuries to the shoulder, which can result in pain.
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 cause of right shoulder pain is unspecified or undetermined. |
|
| M75.111 | Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic | Use when a rotator cuff tear is confirmed by imaging. |
|
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 Right Shoulder Pain
Primary ICD-10-CM Codes for right shoulder pain
Decision Criteria
clinical Criteria
- Pain without confirmed etiology and negative imaging
documentation Criteria
- Lack of specific diagnosis despite clinical evaluation
Applicable To
- Right shoulder joint pain
Excludes
- Pain due to rotator cuff tear (M75.111)
Clinical Validation Requirements
- Localized tenderness on palpation
- Restricted range of motion
- Negative imaging for structural damage
Code-Specific Risks
- Risk of undercoding if specific cause is known but not documented
Coding Notes
- Ensure documentation specifies laterality and any known underlying causes.
M75.111 - Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic
Use when a rotator cuff tear is confirmed by imaging.
Applicable To
- Rotator cuff syndrome of right shoulder
Excludes
- Traumatic rotator cuff tear (S43.421A)
Clinical Validation Requirements
- Positive Hawkins/Kennedy test
- MRI confirmation of rotator cuff tear
Coding Notes
Document imaging results and clinical tests clearly.
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 Right 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: Ambiguity in patient records., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Always specify right or left in clinical notes.
Impact
Reimbursement: Incorrect coding may lead to reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use M75.111 when imaging confirms a rotator cuff tear.
Impact
High risk of audits if shoulder pain is coded without specificity.
Mitigation Strategy
Ensure detailed documentation and use specific codes when applicable.
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 Right Shoulder Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Shoulder Pain
Use these documentation templates to ensure complete and accurate documentation for Right Shoulder Pain. These templates include all required elements for proper coding and billing.
Orthopedic evaluation for right shoulder pain
Specialty: OrthopedicsRequired Elements
- Subjective pain description
- Objective findings
- Imaging results
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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