Left Shoulder Pain ICD 10 Code
Left shoulder pain ICD-10 is a billing code commonly used by physical therapists to report shoulder pain, which is a very common problem. Shoulder pain can develop due to many underlying conditions and often affects how patients function in daily life. It can make Activities of Daily Living difficult, interfere with work and parenting responsibilities, and limit participation in sports and leisure activities.
Summary:
- Physical therapists often use the left shoulder pain ICD-10 code (M25.512) for billing purposes. However, using more detailed ICD-10 codes can improve reimbursement accuracy and better reflect the patient’s actual condition. Enrolling in an insurance billing course for therapists can help providers improve their coding knowledge.
- Shoulder pain may be caused by conditions such as rotator cuff tears, arthritis, or shoulder impingement. Treatment commonly includes physical therapy techniques such as manual therapy, therapeutic modalities, neuromuscular re-education, and functional training.
Because shoulder pain is seen so frequently in physical therapy practice, it is important to understand how to properly use the left shoulder pain ICD-10 code. In this article, we will explain the left shoulder pain ICD-10 code and review other related codes that can help make billing more specific and increase the chances of accurate and timely reimbursement from insurance payers.
For physical therapists, evaluating shoulder pain helps identify the medical condition contributing to the pain. It also helps recognize problems with body structure and function, as well as limitations in activity and participation. This allows therapists to create focused treatment plans and goals.
Common causes of acute and chronic shoulder pain include:
- Labral tear
- Arthritis
- AC joint separation
- Rotator cuff tear
- Rotator cuff strain
- Shoulder dislocation
- Post-surgical shoulder pain
- Shoulder fracture
- Adhesive capsulitis
- Bicipital tendinopathies
- Shoulder impingement
- Overuse injuries
Treatment options for shoulder pain may include medication, injections, arthroscopic or open surgery, and physical therapy. Physical therapy is often the first conservative treatment choice for many shoulder conditions. Physical therapists use a variety of treatment methods to reduce pain and restore function.
Common physical therapy techniques include:
- Manual therapy: Soft tissue mobilization, myofascial release, ASTYM techniques, and joint mobilization
- Modalities: Ultrasound, electrical stimulation, laser therapy, cryotherapy, thermotherapy, and dry needling
- Therapeutic exercise: Stretching, passive, active, and active-assisted range of motion exercises, strength training, endurance, and power exercises
- Neuromuscular re-education: Training focused on motor control, joint stability, and muscle coordination
- Functional training: Work-, sport-, and activity-specific exercises to help patients safely return to previous activity levels
- Patient education: Teaching patients how to modify activities, follow a home exercise program, manage pain, and prevent future injuries
An Introduction to ICD-10 Codes
Many therapists are familiar with searching for and selecting left shoulder pain ICD-10 codes but may not fully understand who uses these codes and why they are required. This section provides a basic overview of ICD-10 coding.
Who: All HIPAA-covered healthcare providers, including physical therapists, must submit ICD-10 codes when requesting reimbursement from insurance companies.
What: The International Classification of Diseases, 10th Revision (ICD-10), is a system of diagnosis and procedure codes used daily in healthcare settings. ICD-10 codes are alphanumeric and contain three to seven characters, with a decimal placed after the third character. More characters mean greater detail and specificity.
Each ICD-10 code follows this structure:
- Characters 1–3: Diagnosis category
- Characters 4–6: Cause, location, severity, or other clinical details
- Character 7: Extension value, such as:
- A: Initial encounter (care related to the first visit for the injury)
- D: Subsequent encounter (routine care during recovery, often rehabilitation)
- S: Sequela (conditions that result from the original injury)
For fracture care, additional extensions may be used, such as P, G, or K, which indicate delayed healing, malunion, or nonunion.
When: ICD-10 codes must be submitted along with proper documentation whenever reimbursement is requested for covered services.
Why: Although ICD-10 coding adds an extra step to documentation and billing, it is required for an important reason. These codes identify the medical diagnosis and help insurance companies understand why the provided care is medically necessary and eligible for reimbursement.
Left Shoulder Pain ICD-10 Codes
What is the ICD-10 code for left shoulder pain?
The ICD-10 code for left shoulder pain is M25.512. This code is used when a patient has pain or discomfort in the left shoulder, whether the pain is acute (less than three months) or chronic (more than three months).
The left shoulder pain ICD-10 code can be used for both shoulder joint and AC joint pain. While it is acceptable for billing, it does not describe the specific condition causing the pain. In many cases, more detailed ICD-10 codes may better represent the patient’s diagnosis.
Examples of more specific left shoulder pain ICD-10 codes include:
| ICD-10 Code | Description |
|---|---|
| S46.012A | Strain of the rotator cuff muscles and tendons of the left shoulder, initial encounter |
| S43.52XD | Sprain of the left acromioclavicular joint, subsequent encounter |
| M75.42 | Impingement syndrome of the left shoulder |
| M75.22 | Bicipital tendinitis, left shoulder |
| Z47.1 | Aftercare following joint replacement surgery, used with Z96.612 for presence of left artificial shoulder joint |
| Z48.89 | Encounter for other specified surgical aftercare, including musculoskeletal surgery |
The Centers for Medicare and Medicaid Services (CMS) publish updated ICD-10 codes each year. These updates take effect on October 1 and remain valid until September 30 of the following year. Websites such as ICD10 Data can also help providers track coding updates.
Additional Code Considerations for Left Shoulder Pain
Along with primary diagnosis codes, place of occurrence codes (Y92) and external cause codes (V00–Y99) can be used to add more detail. These codes are usually reported during the initial evaluation.
Example for left shoulder pain caused by a fall from a ladder at a construction site:
- Y92.6: Building under construction as the place of occurrence
- W11: Fall on or from a ladder
While treating left shoulder pain and correctly billing using ICD-10 codes requires effort, managing coding, billing, scheduling, and documentation does not have to be overwhelming.
Hopefully, this guide helps you feel more confident when managing left shoulder pain cases in your physical therapy clinic. Check out our other blogs on the ICD-10 code for difficulty in walking and the low back pain ICD 10.
FAQs About Left Shoulder Pain ICD-10 Codes
What is the ICD-10 code for left shoulder pain?
The ICD-10 code for left shoulder pain is M25.512. It is used for both acute and chronic pain and is accepted for billing and reimbursement.
Are there more specific ICD-10 codes for shoulder pain?
Yes. If shoulder pain is caused by a specific condition such as a rotator cuff tear (S46.012A), impingement syndrome (M75.42), or bicipital tendinitis (M75.22), using a more specific code improves documentation and reimbursement accuracy.
What is the CPT code for left shoulder pain?
| Code | Description |
|---|---|
| M25.512 | Pain in left shoulder |
| M25.519 | Pain in unspecified shoulder |
| M25.521 | Pain in right elbow |
| M25.522 | Pain in left elbow |
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From state-specific ICD-10 requirements to payer documentation rules, we understand the challenges of billing for shoulder pain. Medmax Technologies supports providers nationwide with accurate, compliant billing solutions tailored to your specialty and reimbursement needs.
