Shoulder Pain ICD-10-CM Codes

What ICD-10 codes are used for shoulder pain?

Shoulder pain is a common musculoskeletal complaint, often stemming from joint disorders, overuse injuries, or inflammation of the rotator cuff tendons. It can present as localized pain, referred pain, or even bilateral pain depending on the root cause and severity. To ensure proper diagnosis, medical necessity, and accurate billing, healthcare providers use ICD-10 codes to classify these conditions based on the affected area and underlying pathology.

• M25.511: Pain in right shoulder: This code signifies pain in the shoulder localized to the right shoulder area.
• M25.512: Pain in left shoulder: Used to identify discomfort or severe pain in the left ball and socket joint of the upper arm bone and shoulder socket.
• M25.519: Pain in unspecified shoulder: Applied when unspecified shoulder pain is documented without laterality.
• M75.90: Shoulder lesion, unspecified, unspecified shoulder: Appropriate when the underlying cause is unknown or not well defined.
• M75.00: Adhesive capsulitis of unspecified shoulder: Also called frozen shoulder, this condition leads to chronic pain and stiffness that can hinder physical activities.

Which Shoulder Pain ICD codes are Billable?

• M25.511: Yes
• M25.512: Yes
• M25.519: Yes
• M75.90: Yes
• M75.00: Yes

Clinical Information

• Pain in the shoulder can be acute or chronic pain, often resulting from a rotator cuff tear, rheumatoid arthritis, trauma, or joint pain related to joint disorders. Common causes include overuse injuries, repetitive strain, or degeneration in the shoulder socket or soft tissue structures.
• Evaluation typically starts with a thorough physical examination and may be followed by diagnostic imaging such as X-rays, magnetic resonance imaging (MRI), or ultrasound to assess shoulder problems involving the joint, tendons, or shoulder blade.
• Treatment varies depending on the underlying issue and may involve rest, anti-inflammatory medications, guided exercises from a physical therapist, or surgical intervention in more severe cases. Addressing shoulder pain promptly ensures better recovery outcomes and minimizes disruptions in physical activities.

Synonyms include:

• Pain in shoulder joint
• Shoulder ache
• Shoulder discomfort
• Rotator cuff pain
• Upper arm pain