ICD-10 Code for Right Shoulder Pain
The appropriate ICD-10 code for right shoulder pain is M25.511 (Pain in right shoulder).
Coding Details
The ICD-10-CM coding system provides specific codes for shoulder pain that include laterality (right vs. left), which is an important feature of the ICD-10 system compared to the previous ICD-9 system 1. This specificity allows for more accurate documentation and tracking of the patient's condition.
For shoulder pain, the coding structure follows this pattern:
- M25.51- Pain in shoulder
- M25.511 Pain in right shoulder
- M25.512 Pain in left shoulder
- M25.519 Pain in unspecified shoulder
Additional Considerations for Coding
When coding shoulder pain, consider these important factors:
Specificity: Always code to the highest level of specificity available. Since the question specifically mentions right shoulder pain, M25.511 is the most appropriate code rather than the unspecified code M25.519.
Underlying Causes: If the cause of the shoulder pain is known, a more specific code may be required:
- For rotator cuff disorders: M75.1- codes
- For shoulder impingement: M75.4- codes
- For shoulder arthritis: M19.- codes with appropriate fifth characters
Documentation Requirements: Ensure clinical documentation includes:
- Specific anatomical location (right shoulder)
- Duration of symptoms
- Any known cause or contributing factors
- Associated symptoms
Clinical Assessment Considerations
While not directly related to coding, proper assessment of shoulder pain is important for accurate diagnosis and treatment:
The American College of Radiology recommends plain radiographs with at least 3 views as the first-line imaging for shoulder pain evaluation 2
If radiographs are noncontributory but symptoms persist, MRI without contrast is the preferred next step 2
Diagnostic tests like Neer's test (high sensitivity 88.7%, low specificity 33%) can help screen for conditions like subacromial impingement syndrome 2
Common Pitfalls in Shoulder Pain Coding
Laterality errors: Using unspecified codes (M25.519) when laterality is documented
Lack of specificity: Using general pain codes when more specific codes for the underlying condition exist
Outdated coding practices: Using converted ICD-9 codes without verifying the appropriate ICD-10 equivalent
Remember that accurate coding is essential for proper reimbursement, tracking of outcomes, and communication among healthcare providers. The transition from ICD-9-CM to ICD-10-CM has significantly increased the specificity of codes available for conditions like shoulder pain 3, 1.