ICD-10 Coding for Right Shoulder Conditions(M25.511, M75.111, S46.011A)
Complete ICD-10-CM coding and documentation guide for Right Shoulder Conditions. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Shoulder Conditions
M75.1-M75.9Primary Range
Shoulder lesions
Primary range for rotator cuff and shoulder impingement conditions.
Injury of muscle and tendon at shoulder and upper arm level
Used for traumatic injuries to the 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 |
|---|---|---|---|
| M25.511 | Pain in right shoulder | Use when the patient presents with pain in the right shoulder without a specific underlying condition. |
|
| M75.111 | Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic | Use when imaging confirms a non-traumatic rotator cuff tear. |
|
| S46.011A | Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial encounter | Use for acute traumatic injuries to the rotator cuff. |
|
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 Conditions
Primary ICD-10-CM Codes for right shoulder
Decision Criteria
clinical Criteria
- Pain without structural cause, negative imaging
Applicable To
- Isolated right shoulder pain
Excludes
- Pain due to rotator cuff tear (M75.111)
Clinical Validation Requirements
- Pain persists >6 weeks
- Negative MRI/X-ray
- Excluded referred pain (e.g., cervical)
Code-Specific Risks
- Risk of undercoding if underlying cause is not identified.
Coding Notes
- Ensure documentation specifies right shoulder and excludes other causes.
M75.111 - Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic
Use when imaging confirms a non-traumatic rotator cuff tear.
Applicable To
- Rotator cuff-related pain
Excludes
- Traumatic rotator cuff tear (S46.011A)
Clinical Validation Requirements
- Positive Hawkins-Kennedy test
- Weakness on empty can test
- MRI showing ≥50% thickness tear
Coding Notes
Document specific tests and imaging findings.
S46.011A - Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, initial encounter
Use for acute traumatic injuries to the rotator cuff.
Applicable To
- Acute traumatic rotator cuff injury
Excludes
- Non-traumatic rotator cuff tear (M75.111)
Clinical Validation Requirements
- Mechanism of injury (e.g., fall on outstretched arm)
- MRI-confirmed full-thickness tear
Coding Notes
Ensure documentation includes the mechanism of injury.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Unspecified 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 Right Shoulder Conditions to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M25.511.
Impact
Clinical: Leads to inadequate treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Always specify the condition and laterality., Use detailed clinical documentation.
Impact
Reimbursement: May lead to claim denials., Compliance: Non-compliance with ICD-10 coding rules., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Always specify right or left shoulder in documentation.
Impact
Reimbursement: Potential underpayment for services., Compliance: Failure to meet coding guidelines., Data Quality: Inaccurate representation of patient condition.
Mitigation Strategy
Identify and document the underlying cause of pain.
Impact
Failure to specify right or left shoulder can lead to audit findings.
Mitigation Strategy
Implement mandatory laterality documentation checks.
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 Conditions, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Shoulder Conditions
Use these documentation templates to ensure complete and accurate documentation for Right Shoulder Conditions. These templates include all required elements for proper coding and billing.
Right Shoulder Pain Evaluation
Specialty: OrthopedicsRequired Elements
- History of present illness
- Physical examination findings
- Imaging results
- Special tests performed
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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