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ICD-10 Code M25.512

What is the code M25.512? M25.512 is a billable/specific ICD-10-CM code used to indicate a diagnosis of “Pain in left 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 […]

What is the code M25.512?

M25.512 is a billable/specific ICD-10-CM code used to indicate a diagnosis of "Pain in left 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 M25.512

The M25.512 code specifies that the patient is experiencing pain localized in the left shoulder that has not been attributed to a definitive underlying condition. 

Symptoms commonly associated with M25.512

Patients with left shoulder pain may report:

  • Persistent or intermittent pain in the left 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

Other related ICD-10-CM codes include:

  • M25.511 (Pain in right shoulder): Identifies pain specifically located in the right 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 M25.512 for billing

M25.512 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 left shoulder without specification of the underlying cause.

Instructional guidelines for providers coding M25.512

When coding with ICD-M25.512 for left 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.

M25.512 can also be used alongside codes from category G89, which describe pain as acute or chronic. The use of M25.512 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 M25.512

  • 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 M25.512 coding

Conclusion

The ICD-10-CM code M25.512 is used for accurately documenting cases of left 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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