Are you looking to know about ICD 10 and ICD 11 codes and coding tips for left shoulder pain? In this article, you will learn all about the coding and billing guidelines you will need to code pain the in left shoulder.
What Is Left Shoulder Pain?
Shoulder pain is not a disease itself but a symptom of many underlying conditions. The shoulder is the most mobile joint of the body, and it has a wide range of movements. So there are a lot of factors that can result in left shoulder pain, like any injury, excessive physical activity, or any other acute or chronic condition.
Common Causes of Shoulder pain are:
- Rotator cuff tendinitis
- Torn Cartilage
- Swelling of Bursa
- Frozen Shoulder
- Dislocated shoulder
- Injury due to excessive physical activity
- Shoulder bone fracture
- Spinal cord injury
- Myocardial infarction or ischemic heart disease
Left Shoulder Pain ICD 10
The left shoulder pain ICD 10 code is M25.512.
For the selection of the left shoulder pain ICD 10 codes in the ICD 10 book (ICD 10 CM / PCS Coding: Theory and Practice, 2021/2022 Edition), you have to follow these steps:
Start from chapter ICD 10 CM codes of Diseases of the musculoskeletal system and connective tissue having Codes range from M00–M99.
Then in the category “M20-M25—Other joint disorders.”
Subcategory M25—Other joint disorder, not elsewhere classified
Next, under M25.5 Pain in the joint, we can find Shoulder joint pain and Left shoulder Pain as well.
ICD 10 Left Shoulder Pain With Radiculopathy
Radiculopathy is a condition caused by nerve compression of the spinal cord, and it can cause shoulder pain. In other words, left shoulder pain might be a symptom of Radiculopathy.
Radiculopathy is further divided into subcategories according to regions of the spinal cord. Similarly, ICD 10 CM codes are subcategorized according to the different regions of the spinal cord.
ICD 10 Left Shoulder Pain With Radiculopathy Codes:
- M54.1 Radiculopathy
- M54.10 Site unspecified
- M54.11 Occipito-atlanto-axial region
- M54.12 A cervical region
- M54.13 A cervicothoracic region
- M54.14 A thoracic region
- M54.15 Thoracolumbar region
- M54.16 Lumbar region
- M54.17 Lumbosacral region
- M54.18 Sacral and sacrococcygeal region
Most of the time, shoulder pain is caused by cervical Radiculopathy.
So if a patient came to the doctor with left shoulder pain and was diagnosed with cervical radiculopathy, we will code both conditions M54.12 Cervical Radiculopathy as primary DX code and then M25.512 Left shoulder pain.
Similarly, left shoulder pain could be caused by other types of Radiculopathy. In such cases, we will code accordingly.
Left Shoulder Rotator Cuff Pain ICD 10 Code
According to the ICD 10 guidelines, Rotator cuff injury or tear is divided into three categories based on its laterality and its cause and an unspecified type where cause and laterality are not mentioned.
M75.1 Rotator cuff tear or rupture, not specified as traumatic (Not Billable).
The fourth and fifth character shows the site and extent of injury/tear of the rotator cuff.
Under this category, ICD 10 CM codes for Left shoulder pain with Unspecified, Incomplete, and Complete tear of the rotator cuff of shoulder are as follows:
- M75.102 ICD 10 of nonspecific rotator cuff tear or rupture of left shoulder, not specified as traumatic.
- M75.112 ICD 10 of incomplete rotator cuff tear or rupture of left shoulder, not specified as traumatic
- M75.122 ICD 10 of complete rotator cuff tear or rupture of left shoulder, not specified as traumatic.
ICD 10 Code for M25.512 shoulder pain on the left side should also code with any of the above-mentioned ICD 10 codes.
Billable ICD 10 Codes
Non-billable ICD 10 codes also called “Red codes,” are of the main category and not very specific.
- M25.5 Pain in joint
- M25.51 Pain in the shoulder
These two codes are not specified and are non-billable.
However, ICD 10 codes of their subcategories are more specific and are billable.
- ICD 10 code for left shoulder pain – M25.512 is a billable code.
- ICD 10 code for right shoulder pain – M25.511 is a billable code.
- Pain in the unspecified shoulder – M25.519 is also a billable code.
Chest Pain Radiating To Left Shoulder ICD 10
There are some common conditions of chest pain radiating to left shoulder ICD 10, such as ischemic heart diseases (Angina or MI, Pericarditis, and pleurisy). So ICD 10 codes for these diseases should be coded with the ICD 10 code of left shoulder pain if it is referred Pain.
ICD 10 Codes for Angina according to its types are:
- I20 Angina pectoris—Non-Billable
- I20.0 Unstable angina
- I20.1 Angina pectoris with documented spasm
- I20.8 Other forms of angina pectoris
- I20.9 Angina pectoris, unspecified
ICD 10 Codes for Chest pain according to its causes are:
- R07 Pain in throat and chest—-Non-Billable
- R07.0 Pain in throat
- R07.1 Chest pain on breathing
- R07.2 Precordial pain
- R07.8 Other chest pain—-Non-Billable
- R07.81 Pleurodynia
- R07.82 Intercostal Pain
- R07.89 Other chest pain
- R07.9 Chest pain, unspecified
Along with left shoulder pain ICD 10 M25.512, these codes should be coded as they do not have Exclude 1 condition for each other.
History Of Left Shoulder Pain ICD 10 Code
History of diseases is always mentioned in the medical records of patients, so the disease that caused left shoulder pain can be coded according to the patient’s condition with the following ICD 10 codes:
- ICD 10 code for ‘Personal history of other diseases of the musculoskeletal system and connective tissue‘ is Z87.39.
- ICD 10 code for ‘Personal history of (healed) traumatic fracture‘ is Z87.81.
However, there is no history of left shoulder pain ICD 10 code specifically.
ICD 10 Code For Left Shoulder Pain Due To Accident
A separate chapter of ICD 10 S00-T88 is for External Causes, i.e., ICD 10 code for left shoulder pain due to accident, ICD 10 code for left shoulder pain due to fall etc.
The ICD 10 code for left shoulder pain due to accident differs according to the vehicle and according to its type of patient encounter:
- ICD 10 code V89.2XXA for unspecified motor accident, initial encounter.
- ICD 10 code W19.XXXA for fall, unspecified, initial encounter.
The Left shoulder pain ICD 10 code M25.512, can be documented in the patient’s medical record.
The accident can result in fractures, injury, etc. that would be the reason for pain in the shoulder, so we code the left shoulder fracture according to its type, either closed, opened, or unspecified.
A series of ICD 10 codes for fractures with 6th and 7th characters shows the type of encounter, with the condition of wound or fracture.
ICD 10 code for left shoulder fracture unspecified:
- S42.92 Fracture of the left shoulder girdle, unspecified part
- S42.92XA Initial encounter for closed fracture
- S42.92XB Initial encounter for open fracture
- S42.92XD Subsequent encounter for fracture with routine healing
- S42.92XG Subsequent encounter for fracture with delayed healing
- S42.92XK Subsequent encounter for fracture with nonunion
- S42.92XP Subsequent encounter for fracture with malunion
- S42.92XS Sequela
The left shoulder pain ICD 10 code M25.512 can be coded secondary to the fracture code.
ICD 10 Code For Left Shoulder Pain Unspecified
ICD 10 code for injury of the left shoulder also differs with patient’s encounter type:
- S40.912A Left shoulder injury, initial encounter
- S40.912D Left shoulder injury, subsequent encounter
- S40.912S Left shoulder injury, sequela
The left shoulder pain ICD 10 code M25.512 should be coded primarily in case of the injury.
Left Shoulder Pain ICD 11 Codes
ICD 11 is an updated version of disease classification, so it has a lot of changes and differences from ICD 10.
ICD 11 provides more specific codes. However, like ICD 10, coders have to search for parent codes in the main category rather than for subcategories to get a more specific code. As a result, a cluster code or combination code is the exact code for a specific disease.
In the case of left shoulder pain, the main category is:
Symptoms, signs, or clinical findings of the musculoskeletal system (ME80-MF1Y).
ICD 11 code ME82 for Pain in the joint is the stem code. For more specific code, there is a post coordination option in which we can search for shoulder joint ICD 11 code is XA05J7. XA05J7 is an extension code. ICD 11 code for Left is XK8G is also an extension code.
It should be coded as a cluster code as:
Code: ME82&XA05J7&XK8G—-Pain in the left shoulder.
How To Code Left Shoulder Strain ICD 10 & 11
The following information will help you decipher how to code Left Shoulder Strain when using ICD 10 and ICD 11.
What Is A Left Shoulder Strain?
A strain or sprain is twisting or stretching a joint that results in pain and damage to the ligament.
Shoulder strain usually occurs due to excessive backward force placed on the arm.
Strain is a combined term for muscle and ligament injuries of the ligaments and muscles related to the shoulder joint without dislocation or fracture. In case of a sprain, some ligament fibers may get ruptured, but the continuity of the ligament remains intact.
Left Shoulder Strain ICD 10
Left shoulder strain ICD 10 should be coded according to the type of patient’s encounter.
- S43.402 Sprain of the left shoulder joint Unspecified (NOS) Non-Billable
- S43.402A Initial encounter
- S43.402D Subsequent encounter
- S43.402S Sequela
Alphabetical index directs for “Code also” any open wound if applicable.
Left Shoulder Rotator Cuff Strain ICD 10
- S46.012 Strain of the rotator cuff (muscles and tendons) of left shoulder, Non-Billable
- S46.012A Initial encounter
- S46.012D Subsequent encounter
- S46.012S Sequela
The above codes can be used for the ICD 10 code for left shoulder muscle strain, as well as:
- The strain of Left infraspinatus
- Left infraspinatus tendon tear
- The strain of the Left rotator cuff
- The strain of Left subscapularis
- Left subscapularis tendon tear
- The strain of Left supraspinatus
- Left supraspinatus tendon tear
- Traumatic left rotator cuff tear
- The strain of muscle of the left shoulder
ICD 10 Code For Left Shoulder Muscle Strain
S46.912A ICD 10 code can also be used for the strain of the left shoulder with ICD 10 code M25.512.
ICD 10 Code For Left Shoulder Acromioclavicular Strain
- S43.52 Sprain of left acromioclavicular joint
- S43.52XA Initial encounter
- S43.52XD Subsequent encounter
- S43.52XS Sequela
Left Shoulder Strain ICD 11 Codes
As mentioned earlier, follow the alphabetical index and then verify the code in the tabular index. It will lead to the ICD 11 NC13.5 states that strain or sprain of other or unspecified parts of the shoulder girdle and it includes all types of a strain of shoulder, i.e., a strain of scapula, coracoclavicular strain, and strain of shoulder blade joint. In post coordination, code laterality as XK8G Left and XA05J7 Shoulder joint.
ICD 11 left shoulder strain code NC13.5&XK8G&XA05J7 is cluster code.
- NC13.5 Strain
- XK8G Left
- XA05J7 Shoulder joint
How To Code Left Shoulder Impingement ICD 10 & 11
The following information will help you decide how to code Left Shoulder Impingement when using ICD 10 and ICD 11.
What Is Left Shoulder Impingement?
Shoulder impingement is a very common cause of shoulder pain. It occurs due to continuous rubbing of shoulder tendons or the rotator cuff on the shoulder blade, which is known as the acromion.
This happens due to less space between the acromion and rotator cuff which became narrow as a result of irritation and swelling in the rotator cuff due to excessive physical activity. That’s why athletes suffer from this condition mostly.
A classic symptom of impingement is Pain during shoulder lifting or arm elevation.
Left Shoulder Impingement ICD 10
The left shoulder impingement ICD 10 code is M75.42.
There is no ICD 10 Code in the “Exclude 1” and no “code also” condition. It would be best if you coded any external causes following the musculoskeletal condition code. This indicates the cause of the musculoskeletal condition.
ICD 10 Code For Left Shoulder Subacromial Impingement
ICD 10 code for left subacromial impingement is M75.52.
M75.25 can be used for the following conditions also.
- Coracoid impingement of the left shoulder
- Left shoulder impingement subacromial bursitis
Left Shoulder Calcific Tendonitis With Impingement ICD 10
The left shoulder calcific tendonitis with impingement ICD 10 code is M75.81. Calcific tendinitis is a common cause of impingement syndrome, so you should also use the M75.42 ICD 10 code for left shoulder impingement, if applicable.
Left Shoulder Impingement ICD 11 Codes
- FB53.1&XK8G can be used to code rotator cuff syndrome ICD 11.
- FB53.2&XK8G&XA05J7 can be used to code impingement syndrome of left shoulder ICD 11.
- Code also MG30.31 chronic secondary musculoskeletal pain associated with structural changes.
How to Code Chronic & Acute Shoulder Pain Left Side ICD 10 & 11
The following information will help you to decide how to code chronic left shoulder pain abiding by the ICD 10 & 11 coding guidelines.
What Is Chronic Left Shoulder Pain?
Chronic Pain can be defined as Pain in the left shoulder that persists for more than six months.
Chronic Left Shoulder Pain ICD 10
Specific chronic pain of the left shoulder should be coded with the following code:
- M25.512 Left shoulder pain greater than three months
ICD 10 does not have defined separate acute and chronic shoulder pain on the left side codes. M25.512 is applicable for both acute and chronic pain in the left shoulder.
Chronic Left Shoulder Pain ICD 11 Codes
The stem ICD 11 code MG30 Chronic Pain ICD 11. Similarly, ICD 11 for the left shoulder is XA2ND5.
According to the ICD 11 coding guidelines, extension codes should be used with stem code to specify the anatomy of the condition so that we will code ICD 11 extension code for the left side:
- XK8G Left, Extension code
Code MG30&XA2ND5&XK8G for chronic pain of left shoulder ICD 11.
The following information will help you to decide how to code acute left shoulder pain abiding by the ICD 10 & 11 coding guidelines.
What Is Acute Left Shoulder Pain?
Acute pain is sudden in onset; it usually resolves quickly or lasts less than three months.
ICD 10 does not have defined separate acute and chronic shoulder pain codes. M25.512 is applicable for both acute and chronic pain in the left shoulder.
Acute Left Shoulder Pain ICD 11 Codes
The stem ICD 11 code for Acute Pain is MG31.Y. Similarly, ICD 11 for the left shoulder is XA2ND5.
According to the ICD 11 coding guidelines, extension codes should be used with stem code to specify the anatomy of the condition so that we will code ICD 11 extension code for the Left side.
- XK8G Left, Extension code.
Code MG31.Y& XA2ND5 & XK8G for acute pain of left shoulder ICD 11.
Sources: ICD-10-CM/PCS Coding: Theory and Practice, 2021/2022 Edition
By Sana Akhtar
Expert Medical Coding & Billing