ICD-10 Coding for Right Upper Extremity Pain(M79.621, M79.601, M25.511)
Complete ICD-10-CM coding and documentation guide for Right Upper Extremity Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Upper Extremity Pain
M79.60-M79.62Primary Range
Other and unspecified soft tissue disorders, not elsewhere classified
This range includes codes for pain in specific parts of the upper extremity, such as the arm and shoulder.
Pain, not elsewhere classified
This range includes codes for pain management, particularly when pain is the primary focus of treatment.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M79.621 | Pain in right upper arm | Use when pain is specifically localized to the right upper arm. |
|
| M79.601 | Pain in right arm | Use for pain that affects the entire right arm without specific localization. |
|
| M25.511 | Pain in right shoulder | Use when pain is specifically localized to the right shoulder joint. |
|
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 upper extremity pain
Essential facts and insights about Right Upper Extremity Pain
Primary ICD-10-CM Codes for right upper extremity pain
Decision Criteria
clinical Criteria
- Pain localized to the right upper arm
documentation Criteria
- Documentation must specify 'right upper arm pain'
Applicable To
- Localized pain in the right upper arm
Excludes
- Pain in right shoulder (M25.511)
Clinical Validation Requirements
- Tenderness on palpation of the right upper arm
- Pain localized between the shoulder and elbow
Code-Specific Risks
- Risk of using unspecified codes when specific location is known
Coding Notes
- Ensure documentation specifies the exact location and laterality of the pain.
M79.601 - Pain in right arm
Use for pain that affects the entire right arm without specific localization.
Applicable To
- Diffuse pain in the right arm
Excludes
- Pain in right upper arm (M79.621)
Clinical Validation Requirements
- Pain spanning from shoulder to hand
- No specific localization to upper arm
Coding Notes
Ensure documentation specifies the entire arm is affected.
M25.511 - Pain in right shoulder
Use when pain is specifically localized to the right shoulder joint.
Applicable To
- Localized pain in the right shoulder joint
Excludes
- Pain in right upper arm (M79.621)
Clinical Validation Requirements
- Positive Hawkins/Kennedy impingement signs
- Pain localized to the shoulder joint
Coding Notes
Ensure documentation specifies the shoulder joint is affected.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Acute pain due to trauma
G89.11Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Right Upper Extremity Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M79.621.
Impact
Clinical: May lead to incorrect treatment plans., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always specify right or left in documentation, Use templates that prompt for laterality
Impact
Reimbursement: May lead to claim denials or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases the accuracy of health data.
Mitigation Strategy
Always document and code the specific location of the pain.
Impact
Risk of audits due to use of unspecified codes.
Mitigation Strategy
Use the most specific codes available and ensure documentation supports code selection.
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 Upper Extremity Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Upper Extremity Pain
Use these documentation templates to ensure complete and accurate documentation for Right Upper Extremity Pain. These templates include all required elements for proper coding and billing.
Orthopedic evaluation for right upper extremity pain
Specialty: OrthopedicsRequired Elements
- Location of pain
- Quality and intensity of pain
- Aggravating and relieving factors
- Physical examination findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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