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ICD-10 Guide
DiagnosesAdhesive Capsulitis

Adhesive Capsulitis

ICD-10 Coding for Adhesive Capsulitis(M75.0, M75.01, M75.02)

PRIMARY SPECIALTYOrthopedics
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Adhesive Capsulitis?
Essential facts and insights about Adhesive Capsulitis

Key Clinical Considerations:

  • Patients typically present with shoulder pain and stiffness, particularly in the range of motion.
  • Diagnostic tests may include MRI or ultrasound to rule out other shoulder pathologies.
  • Physical examination often reveals limited active and passive range of motion in the shoulder joint.
  • Imaging findings may show thickening of the joint capsule and reduced joint space.
  • Severity can be classified into stages: freezing (painful), frozen (stiffness), and thawing (resolution).

Clinical Information

Clinical Criteria & Documentation Requirements

  • Medical records must document the patient's history, physical examination findings, and any imaging results.
  • Specific terminology such as 'frozen shoulder' or 'adhesive capsulitis' must be used consistently.
  • Examples include documenting the degree of range of motion and pain levels during assessment.
  • Medical necessity must be established through documentation of functional limitations and treatment rationale.
  • Quality measures may include tracking patient-reported outcomes and functional improvement.

Coding Guidelines

Usage Guidelines & Examples

  • Use M75.0 for adhesive capsulitis of the shoulder; M75.01 for right shoulder and M75.02 for left shoulder.
  • Do not use this code for shoulder pain due to rotator cuff tears or other specific shoulder conditions.
  • M75.0 is distinct from M75.1 (shoulder bursitis) and M75.3 (impingement syndrome) as they have different clinical presentations.
  • Common errors include using the wrong laterality code or misclassifying the condition as a different shoulder pathology.
  • In complex cases, ensure to document all relevant findings to support the selected code.

Code Exclusions

Important Exclusions

  • Excludes conditions such as rotator cuff tears (M75.1) and shoulder bursitis (M75.2).
  • Alternative codes for excluded conditions include M75.10 for unspecified rotator cuff tear.
  • Conditions are excluded due to differing pathophysiology and treatment approaches.
  • Common mistakes include misdiagnosing adhesive capsulitis when the primary issue is a rotator cuff injury.
  • Related but distinct conditions include shoulder osteoarthritis and tendinitis.

Related ICD-10 Codes

Primary Codes
M75.0
Adhesive capsulitis of shoulder
M75.01
Adhesive capsulitis of right shoulder
M75.02
Adhesive capsulitis of left shoulder
Ancillary Codes
M25.51-
Z47.89
Differential Codes
M75.1
M75.4

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Orthopedics

Specialty Applications

  • This diagnosis applies to patients with shoulder pain and limited range of motion, often seen in middle-aged individuals.
  • Higher prevalence in females and those with diabetes or thyroid disorders.
  • Clinical settings include outpatient orthopedic clinics and physical therapy facilities.
  • Specialty-specific applications are relevant in orthopedics and rehabilitation medicine.
  • Treatment contexts include conservative management with physical therapy and potential surgical intervention.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Template 1

Template: 'Patient diagnosed with adhesive capsulitis based on clinical findings of limited range of motion.'

Template 2

Template: 'Clinical presentation consistent with adhesive capsulitis including shoulder pain and stiffness.'

Template 3

Template: 'Diagnostic criteria for adhesive capsulitis met as evidenced by MRI findings of joint capsule thickening.'

Template 4

Template: 'Treatment plan initiated for adhesive capsulitis with physical therapy and pain management.'

Template 5

Template: 'Follow-up care for adhesive capsulitis including monitoring of range of motion and pain levels.'

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

What documentation is required for this diagnosis?

Documentation should include patient history, physical exam findings, and imaging results.

How does this differ from similar diagnoses?

Adhesive capsulitis is characterized by specific patterns of pain and stiffness, unlike rotator cuff injuries.

What are common billing considerations?

Ensure to document medical necessity and functional limitations to optimize claims.

What procedures are typically associated?

CPT codes for physical therapy and possible surgical interventions may be relevant.

Are there any quality reporting implications?

Quality measures may include tracking functional improvement and patient satisfaction.