(2022) How To Code Right Shoulder Pain ICD 10 – Codes & Guidelines

ICD 10 right shoulder pain coding is made easier with our billing guidelines. This article includes all medical codes you will need to report right shoulder pain and related specific ICD 10 & 11 codes. Read on for a summary of the necessary codes followed by a description.

What Is Pain In The Right Shoulder?

The shoulder is the most mobile joint in the body, and it is one of the most used joints in the human body.

Thus, Shoulder pain is widespread. It’s possible that shoulder pain can radiate down into the arm. Conversely, a condition affecting the upper arm may be felt around your shoulder.

Not only musculoskeletal causes can cause shoulder pain. Visceral disorders such as myocardial infarction and ruptured ectopic pregnancy may be felt around the shoulder region. 

There are several reasons why a person may experience pain in their right shoulder and arm. In many cases, the pain will occur due to muscle overuse, injury, or nerve damage.

Shoulder pain is the third-leading trusted Source muscle and bone complaint in the United States.

Right shoulder pain varies in intensity and character depending on the cause. The pain may be constant or occur when using the shoulder.

Sometimes, shoulder pain can be severe enough to interfere with daily activities.

If nerve damage contributes to shoulder pain, it can cause numbness and tingling in the arm.

Shoulder pain may be severe and sudden for injuries such as a fracture, sprain, or conditions such as the frozen shoulder.

Stiffness and reduced range of motion may also develop. Sometimes, shoulder pain can extend into the neck as well.

Causes of right shoulder pain include: 

Rotator cuff diseases such as tendinitis, bursitis, and impingement

Rotator cuff tear

Shoulder dislocation

Clavicular fracture

Humeral fracture

Frozen shoulder

Calcific tendonitis

Shoulder dislocation

Shoulder Osteoarthritis

Shoulder rheumatoid arthritis

Cervical radiculopathy

Brachial neuritis

Brachial plexus injury

Thoracic outlet syndrome

Treatment of shoulder pain depends on the Etiology. However, RICE (Rest, Ice, Compression, Elevation) may help elevate symptoms, analgesics, and even proper resting and posturing may also help. 

However, more severe cases may need immobilization, corticosteroids injection, Drugs, particular physical therapy, and surgery may be done. 

ICD 10 Right Shoulder Pain

ICD 10 right shoulder pain is coded as pain in the shoulder joint M25.51. 

This can be selected in Chapter 13 of the ICD 10 book Diseases of the musculoskeletal system and connective tissue coded as (M00-M99).

It is then located in the block. Other joint disorders are coded as (M20-M25).

The categories under this block include:

M20 – Acquired deformities of fingers and toes.

M21 – Other acquired deformities of limbs. 

M22 – Disorder of patella.

M23 – Internal derangement of the knee.

M24 – Other specific joint derangements two indications for 73 drugs.

M25 – Other joint disorder, not elsewhere classified. 

The category M25 ( other joint disorders not elsewhere classified ) has the following subcategories: 

M25.0 – Hemarthrosis

M25.1 – Fistula of joint

M25.2 – Flail joint 

M25.3 – Other instability of joint

M25.4 – Effusion of joint

M25.5 – Pain in joint

M25.6 – Stiffness of joint, not elsewhere classified

M25.7 – Osteophyte

M25.8 – Other specified joint disorders

M25.9 – Joint disorder, unspecified

The subcategories pain in joint (M25.5) has the following subcodes:

M25.50 – Pain in unspecified joint

M25.51 – Pain in the shoulder

M25.52 – Pain in the elbow

M25.53 – Pain in wrist

M25.54 – Pain in joints of the hand

M25.55 – Pain in the hip

M25.56 – Pain in the knee

M25.57 – Pain in ankle and joints of the foot

Each of these joints is assigned codes based on which side is affected.

The right side of the body is generally assigned M25.5X1 while that of the left side is M25.5X2, and unspecified joint as M25.5X9. 

For example, pain in the shoulder (M25.51) will be coded as 

M25.511 – Pain in the right shoulder

M25.512 – Pain in the left shoulder

M25.519 – Pain in the unspecified shoulder

M25.511 is a billable/specific ICD 10 CM code that can be used to indicate a diagnosis for reimbursement purposes.

The 2022 edition of ICD 10 CM M25.511 became effective on October 1, 2021.

Approximate synonyms that may be used for this code include: 

Pain of right acromioclavicular joint

Bilateral acromioclavicular joint pain

Bilateral shoulder joint pain

Bilateral shoulder joint pain greater than three months

The pain of the right shoulder joint

Right acromioclavicular joint pain

Right shoulder joint pain

Pain of right acromioclavicular joint

Right acromioclavicular joint pain

Right shoulder joint pain

Right shoulder pain

Right sternoclavicular joint pain

Chronic Right Shoulder Pain ICD 10

There is no unique code to describe the literality of chronic right shoulder pain, but it can be coded as M25.51, which codes right shoulder pain, G89.21, which codes for chronic pain due to trauma.

However, chronic pain is coded as G89.4 generally, which can be located in chapter VI Diseases of the nervous system G00-G99, under block Other disorders of the nervous system G89-G99, Pain, not elsewhere classified G89-.

Acute Pain Of Right Shoulder ICD 10

There is no unique code to describe the literality of acute right shoulder pain.

Still, it can be coded as M25.51, which codes right shoulder pain, G89.11, which codes for acute pain due to trauma.

However, acute pain is coded as G89.4 generally, located in the same chapter block and category with the described chronic pain.

A patient could present with right shoulder pain following osteoarthritis, which is coded as M19.011, a subcategory primary osteoarthritis right shoulder.

A patient could present with right shoulder pain following pyogenic arthritis, which is coded as M00.011 staphylococci arthritis, right shoulder, M00.111 pneumococcal arthritis, right shoulder.

A patient could present with right shoulder pain due to the inflammation of the capsules around the shoulder joint. It is coded as M75.01 adhesive capsulitis of the right shoulder.

A patient could present with right shoulder pain following a rupture or tear of the rotator cuff muscles, and it is coded as M75.101.

A patient could present with right shoulder pain following an inflammation reaction of the tendon of the muscles around the shoulder joint. It is coded as M75.21 Bicipital tendinitis right shoulder.

It can also be due to the calcification of a tendon around the joint. Therefore it is coded as M75.31.

The patient can present with right shoulder pain following an inflammation of the bursa (bursitis), which serves as a cushion around the joint. It is coded as M75.51 bursitis of the right shoulder.

Pain in the right shoulder could follow an abrasive injury which can be coded as:

Abrasion of right shoulder initial encounter S40.212A,

Abrasion of right shoulder subsequent encounter S40.212D, 

Abrasion of right shoulder sequelae S40.212S.

Right shoulder pain could result from a fracture of the scapula, displaced fracture of the neck of the right scapula shoulder, initial encounter, subsequent and sequelae for closed fracture are coded respectively as S42.151A S42.151D and S42.151S.

Right Shoulder Pain ICD 11

Shoulder joint pain is not explicitly coded in the ICD 11 MMS book.

However, shoulder disorders, many of which can produce pain as their symptoms, are coded in chapter 15, Diseases of the musculoskeletal system or connective tissue.

By selecting Soft tissue disorders (FB30-FB6Z) and Miscellaneous specified soft tissue disorders (FB50-FB56.6).

FB53 specifically codes for shoulder disorders, and the sections/codes include: 

Adhesive capsulitis of the shoulder (FB53.0).

Rotator cuff syndrome  (FB53.1).

Impingement syndrome of the shoulder (FB53.2).

Other specified shoulder lesions (FB53.Y).

Shoulder lesions, unspecified (FB53.Z).

Adhesive capsulitis of the shoulder (FB53.0) has the following synonyms: 

Adhesive capsulitis of the shoulder

Frozen shoulder

Pericapsulitis of shoulder

Display bursitis

Adhesive shoulder peritendinitis

Subscapular adhesion

Shoulder adhesion

Adhesive enthesopathy of the shoulder region

Adhesive peritendinitis

Adhesive shoulder tenosynovitis

Duplay periarthritis

Adhesive shoulder tendinitis

Periarthritis of shoulder

Rotator cuff syndrome  

(FB53.1) has the following synonyms: 

Rotator cuff syndrome

Impingement syndrome

Rotator cuff rupture

Rotator cuff tear

Rupture of the rotator cuff of the shoulder

Rotator cuff syndrome NOS

Spontaneous rupture of the rotator cuff tendon

Complete rotator cuff or supraspinatus tear or rupture, not specified as traumatic

Complete rupture of rotator cuff

Incomplete rotator cuff or supraspinatus tear or rupture, not specified as traumatic

Rupture supraspinatus tendon

Supraspinatus rupture

Supraspinatus syndrome NOS

Supraspinatus tear

Supraspinatus tear

Impingement syndrome of the shoulder  (FB53.2) has the following synonyms: 

Impingement syndrome of the shoulder

Impingement syndrome of the shoulder region

Subacromial impingement

Other specified shoulder lesions (FB53.Y) has the following synonyms:

Other specified shoulder lesions

Disorder of tendon of the shoulder region

Disease of the tendon of the shoulder region

Scapulohumeral fibrositis

Scapulohumeral myofibrosis

Shoulder pain

Shoulder tenosynovitis

Scapulohumeral myofibrositis

Shoulder lesions, unspecified (FB53.Z), has the following synonyms:

Shoulder lesions, unspecified

Shoulder lesions

Enthesopathy of the shoulder region

Lesion of shoulder

Other common causes of shoulder pain classified elsewhere include: 

Shoulder hand syndrome  (FB56.5)

Rotator cuff tendonitis  (FB40.3)