M25.511: Pain in right shoulder
Billable ICD-10-CM code, FY2027
What M25.511 covers
M25.511 is for pain in the right shoulder without a more specific diagnosis. It is a symptom code used while the cause is unclear or not yet documented.
Primary care, orthopedics, sports medicine and physical therapy use it. The left shoulder is M25.512 and an unspecified side is M25.519. Once a cause is documented, codes from M75.- often fit better, such as rotator cuff disorders (M75.1-), adhesive capsulitis (M75.0-) or impingement (M75.4-).
Billing and coding notes
Laterality is part of the code. Pain in both shoulders is reported with M25.511 and M25.512, since there is no bilateral shoulder pain code.
Shoulder pain from a recent injury is usually coded in chapter 19 with a seventh character for the encounter. When a definitive diagnosis explains the pain, M25.511 is not added on top of it.
Related codes under M25.51
Questions about M25.511
How do you code pain in both shoulders?
Report M25.511 for the right shoulder and M25.512 for the left. There is no bilateral shoulder pain code.
Can M25.511 be coded with a rotator cuff code?
Generally not for the same shoulder. Pain is part of a rotator cuff disorder, and the guidelines say symptoms that are part of a confirmed diagnosis are not coded separately.
ICD-10-CM in CloudMedico
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