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v1.0.0
ICD-10 Guide
DiagnosesPain Left Shoulder

Pain Left Shoulder

ICD-10 Coding for Pain in Left Shoulder(M25.512, M75.42)

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

Diagnosis Overview

What is Pain Left Shoulder?
Essential facts and insights about Pain in Left Shoulder

Key Clinical Considerations:

  • Localized pain in the left shoulder, possibly radiating to the arm or neck
  • Imaging studies such as X-rays or MRI showing rotator cuff tears or impingement
  • Tenderness upon palpation of the shoulder joint and limited range of motion

Clinical Information

Clinical Criteria & Documentation Requirements

  • Patient history including onset, duration, and nature of pain
  • Specific terminology such as 'left shoulder pain' or 'shoulder impingement syndrome'
  • Examples include detailed descriptions of physical exam findings and imaging results

Coding Guidelines

Usage Guidelines & Examples

  • Usage guidelines emphasize specificity in coding shoulder pain based on underlying conditions.
  • Common errors include using general codes instead of specific ones for shoulder diagnoses.

Code Exclusions

Important Exclusions

  • Fractures of the shoulder girdle or other traumatic injuries
  • Alternative codes for right shoulder pain or unspecified shoulder pain

Related ICD-10 Codes

Primary Codes
M75.12
Rotator cuff tear or rupture, left shoulder
M25.512
Pain in left shoulder
Ancillary Codes
Z96.612
Differential Codes
M75.42
M75.02
M25.512
M25.512
if no specific cause is identified.

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Orthopedics

Specialty Applications

  • Adults with shoulder pain, athletes, and individuals with repetitive overhead activities
  • Orthopedic clinics, physical therapy centers, and urgent care facilities

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

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

Documentation requirements?

Include detailed patient history, physical exam findings, and imaging results.

Billing considerations?

Ensure accurate coding to reflect the specific diagnosis and any associated procedures.