ICD-10 Code M25.511
What is the code M25.511?
M25.511 is a billable/specific ICD-10-CM code used to indicate a diagnosis of "Pain in right shoulder." This code falls under the chapter of diseases of the musculoskeletal system and connective tissue (M00 - M99), specifically category M25 Other joint disorder, not elsewhere classified. It is utilized for both clinical documentation and billing purposes in various healthcare settings.
Detailed description of M25.511
The M25.511 code specifies that the patient is experiencing pain localized in the right shoulder that has not been attributed to a definitive underlying condition.
Symptoms commonly associated with M25.511
Patients with right shoulder pain may report:
- Persistent or intermittent pain in the right shoulder
- Reduced range of motion
- Pain that worsens with movement or during specific activities
- Swelling or tenderness around the shoulder
- Weakness or instability in the shoulder
Related and similar ICD-10 codes
Other related ICD-10-CM codes include:
- M25.512 (Pain in left shoulder): Identifies pain specifically located in the left shoulder.
- M25.51 (Pain in shoulder), when the side is not specified. These codes help to specify the exact location and side of the pain for more accurate diagnosis and treatment.
Appropriate usage of M25.511 for billing
M25.511 should be used for billing when a provider includes in the assessment portion of their note that a patient presents with symptoms of pain that are localized to the right shoulder without specification of the underlying cause.
Instructional guidelines for providers coding ICD-M25.511
When coding with ICD-M25.511 for right shoulder pain, it is encouraged to include detailed documentation of diagnostic criteria met, the symptoms observed and any supporting imaging studies. While this detailed documentation is not necessary for physician billing, including the below enhances the clarity and accuracy of the medical record:
- A comprehensive patient history to explore potential causes of the pain.
- A detailed physical examination of the shoulder.
- Any relevant imaging or tests to confirm or exclude specific pathologies.
M25.511 can also be used alongside codes from category G89, which describe pain as acute or chronic. The use of M25.511 in conjunction with a G89 code should be based on the specifics of the clinical encounter. This allows for a more detailed description of the pain's nature, aiding in accurate and effective patient management.
Common pitfalls in coding with M25.511
- Misclassification of shoulder pain when a more specific underlying diagnosis is evident.
- Failing to update the code if the provider lists an updated diagnosis in the assessment portion of a note
Key resources for M25.511 coding
- CMS ICD-10 Homepage: Provides official resources and guidelines for ICD-10-CM coding.
- WHO ICD-10 Online Browser: Useful for checking the specifics of musculoskeletal system codes.
Conclusion
The ICD-10-CM code M25.511 is used for accurately documenting cases of right shoulder pain. Proper use of this code facilitates appropriate treatment planning, ensures accurate billing, and supports the management of patients presenting with shoulder pain, enhancing their overall care.
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