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v1.0.0
ICD-10 Guide
DiagnosesRight Shoulder Injury

Right Shoulder Injury

ICD-10 Coding for Right Shoulder Injury(S43.401A, M25.511)

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

Diagnosis Overview

What is Right Shoulder Injury?
Essential facts and insights about Right Shoulder Injury

Key Clinical Considerations:

  • Pain in the right shoulder, limited range of motion, swelling or bruising
  • X-ray to rule out fractures, MRI for soft tissue injuries, ultrasound for joint effusion
  • Tenderness over the shoulder joint, decreased strength, positive impingement test

Clinical Information

Clinical Criteria & Documentation Requirements

  • Patient history, mechanism of injury, physical exam findings, imaging results
  • ICD-10-CM codes for shoulder injuries, specific terms like 'dislocation', 'strain', 'fracture'
  • Example: 'Patient presents with right shoulder pain after a fall, X-ray shows no fracture.'

Coding Guidelines

Usage Guidelines & Examples

  • Follow guidelines for specificity in coding shoulder injuries.
  • Common errors include using unspecified codes when specific codes are available.

Code Exclusions

Important Exclusions

  • Fractures of the clavicle, left shoulder injuries
  • Alternative codes for chronic conditions or previous injuries

Related ICD-10 Codes

Primary Codes
S43.001A
Unspecified dislocation of right shoulder joint, initial encounter
S40.011A
Strain of muscle, fascia and tendon of right shoulder, initial encounter
S42.001A
Fracture of the surgical neck of the right humerus, initial encounter
Ancillary Codes
M25.511
Differential Codes
M75.121
S43.401A

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Emergency Medicine

Specialty Applications

  • Adults and children with shoulder injuries, sports injuries, falls
  • Emergency departments, urgent care centers, outpatient clinics

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?

Document mechanism of injury, symptoms, and physical exam findings.

Billing considerations?

Ensure accurate coding based on diagnosis and associated procedures.