ICD-10 Code for Chronic Bilateral Shoulder Joint Pain
The appropriate ICD-10 diagnosis code for chronic bilateral shoulder joint pain is M25.512 (Pain in left shoulder) and M25.511 (Pain in right shoulder), or more specifically M25.519 (Pain in unspecified shoulder) if bilateral coding is not required by your documentation system.
Primary Coding Options
For bilateral shoulder pain, you should assign both:
Alternatively, if your system allows for bilateral designation or if specificity is not required:
- M25.519 - Pain in unspecified shoulder 1
Condition-Specific Codes (If Etiology is Known)
If the chronic bilateral shoulder pain has an identified underlying cause, more specific codes from the M75 category should be used instead 1:
Rotator Cuff Disorders (Most Common):
- M75.1 - Rotator cuff syndrome (includes impingement syndrome) 2, 1
- M75.10 - Unspecified rotator cuff tear or rupture
- M75.11 - Incomplete rotator cuff tear or rupture
- M75.12 - Complete rotator cuff tear or rupture 2
Other Specific Shoulder Conditions:
- M75.0 - Adhesive capsulitis (frozen shoulder) 2, 3
- M75.2 - Bicipital tendinitis 4
- M75.3 - Calcific tendinitis 3
- M75.4 - Impingement syndrome 1
- M75.5 - Bursitis of shoulder 3
Acromioclavicular Joint Pathology:
- M19.01 - Primary osteoarthritis of right acromioclavicular joint 2
- M19.02 - Primary osteoarthritis of left acromioclavicular joint 2
Glenohumeral Arthritis:
- M19.011 - Primary osteoarthritis of right shoulder (glenohumeral joint) 2, 4
- M19.012 - Primary osteoarthritis of left shoulder (glenohumeral joint) 2, 4
Critical Coding Considerations
The M75 category codes are the most frequently used for shoulder pain diagnoses, with rotator cuff and impingement syndromes being the most common specific diagnoses in clinical practice 1. In a population-based study, approximately 1% of patients consulted annually for shoulder pain conditions coded under M75, with peak incidence in ages 50-69 1.
Age-based diagnostic patterns should guide your code selection:
- Patients under 35-40 years: Consider instability-related codes (M24.41 for recurrent dislocation) or labral pathology 5, 2
- Patients over 35-40 years: Rotator cuff disease (M75.1) and degenerative changes (M19.01x) are predominant 5, 2
Common Pitfalls to Avoid
Do not use M25.51x codes if a specific underlying pathology has been identified - the more specific M75 codes take precedence for documented shoulder pathology 1. The generic "shoulder pain" codes should only be used when the etiology remains unclear after appropriate evaluation 2.
Bilateral coding requires separate codes for each side - there is no single bilateral code in ICD-10 for shoulder pain 1. You must assign both M25.511 and M25.512 (or the appropriate bilateral M75 codes) to accurately capture bilateral involvement.
Chronic pain designation - While ICD-10 does not have a specific "chronic" modifier for M25.51x codes, the chronicity is implied by the clinical context and documentation. If pain has been present for more than 6 months, this meets the definition of chronic shoulder pain 2.