ICD-10 Coding for Shoulder Discomfort(M25.512, M75.42)
Complete ICD-10-CM coding and documentation guide for Shoulder Discomfort. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Shoulder Discomfort
Injury of muscle and tendon at shoulder and upper arm level
Traumatic injuries to shoulder muscles or tendons
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M25.512 | Pain in left shoulder | Use when shoulder pain is the primary complaint without a specific diagnosis |
|
| M75.42 | Impingement syndrome of shoulder | Use when impingement syndrome is confirmed |
|
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 shoulder discomfort
Essential facts and insights about Shoulder Discomfort
Primary ICD-10-CM Codes for shoulder discomfort
Decision Criteria
clinical Criteria
- Pain without specific diagnosis
Applicable To
- Left shoulder pain
Excludes
- Pain due to specific shoulder conditions (e.g., rotator cuff tear)
Clinical Validation Requirements
- Patient history indicating pain duration and intensity
- Physical examination showing limited range of motion
Code-Specific Risks
- Risk of undercoding if specific shoulder condition is present
Coding Notes
- Ensure documentation specifies laterality and duration
M75.42 - Impingement syndrome of shoulder
Use when impingement syndrome is confirmed
Applicable To
- Shoulder impingement
Excludes
- Pain without impingement
Clinical Validation Requirements
- Positive Hawkins or Neer test
- Imaging confirming impingement
Coding Notes
Document clinical tests and imaging results
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Impingement syndrome of shoulder
M75.42Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Shoulder Discomfort to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M25.512.
Impact
Clinical: Inaccurate diagnosis, Regulatory: Potential audit issues, Financial: Claim denials
Mitigation Strategy
Use standardized templates, Train staff on documentation requirements
Impact
Reimbursement: May lead to lower reimbursement, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate clinical data
Mitigation Strategy
Use specific codes like M75.42 for impingement
Impact
Risk of audits due to non-specific coding
Mitigation Strategy
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 Shoulder Discomfort, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Shoulder Discomfort
Use these documentation templates to ensure complete and accurate documentation for Shoulder Discomfort. These templates include all required elements for proper coding and billing.
Chronic shoulder pain evaluation
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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