ICD-10 Coding for Scapular Pain(M25.511, M25.512)
Complete ICD-10-CM coding and documentation guide for Scapular Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Scapular Pain
M25.51-M25.52Primary Range
Pain in shoulder
This range includes codes for pain localized to the shoulder region, including the scapula.
Myalgia
This code is used for muscle pain, which can include myofascial pain in the scapular region.
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 pain is localized to the right scapula, confirmed by clinical tests. |
|
| M25.512 | Pain in left shoulder | Use when pain is localized to the left scapula, confirmed by clinical tests. |
|
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 scapular pain
Essential facts and insights about Scapular Pain
Primary ICD-10-CM Codes for scapular pain
Decision Criteria
clinical Criteria
- Pain localized to the right scapula with positive SAT
documentation Criteria
- Detailed note specifying right scapular pain
Applicable To
- Pain localized to the right scapula
Excludes
- Pain in thoracic spine (M54.6)
Clinical Validation Requirements
- Positive Scapular Assistance Test (SAT)
- Imaging showing subacromial impingement
Code-Specific Risks
- Confusion with general shoulder pain codes
Coding Notes
- Ensure documentation specifies laterality and localization to the scapula.
M25.512 - Pain in left shoulder
Use when pain is localized to the left scapula, confirmed by clinical tests.
Applicable To
- Pain localized to the left scapula
Excludes
- Pain in thoracic spine (M54.6)
Clinical Validation Requirements
- Positive Scapular Retraction Test (SRT)
- MRI showing scapular malpositioning
Coding Notes
Ensure documentation specifies laterality and localization to the scapula.
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.
Pain in thoracic spine
M54.6Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Scapular 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: Ambiguous diagnosis affecting treatment., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always specify laterality in documentation.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Use M25.51- for scapular pain unless thoracic spine involvement is documented.
Impact
Failure to document laterality can lead to audit flags.
Mitigation Strategy
Implement mandatory laterality fields in EHR templates.
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 Scapular Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Scapular Pain
Use these documentation templates to ensure complete and accurate documentation for Scapular Pain. These templates include all required elements for proper coding and billing.
Orthopedic Progress Note
Specialty: OrthopedicsRequired Elements
- Subjective: Patient's pain description and duration
- Objective: Physical exam findings and test results
- Assessment: Diagnosis codes
- Plan: Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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