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Common ICD 10 Codes: Pain in Right Shoulder Diagnosis

JH
John H
Health Enthusiastt
18 min read

Common ICD-10 Codes: Pain in Right Shoulder Diagnosis

Shoulder pain is one of the most frequent musculoskeletal complaints seen in clinical practice. Whether caused by injury, overuse, or underlying medical conditions, pain in the right shoulder can significantly impact daily activities, sleep, and overall quality of life. For healthcare providers, accurate diagnosis and documentation are essential—not only for effective treatment but also for proper medical coding and billing. The International Classification of Diseases, 10th Revision (ICD-10), provides standardized codes that ensure consistency across medical records, insurance claims, and healthcare systems.

In this comprehensive guide, we explore the common ICD-10 codes associated with pain in the right shoulder, the conditions they represent, and how proper coding impacts patient care and reimbursement. We'll also discuss diagnostic considerations, treatment approaches, and frequently asked questions to help both medical professionals and patients understand the nuances of shoulder pain diagnosis and management.

Understanding ICD-10 Coding for Shoulder Pain

ICD-10 codes are alphanumeric designations used globally to classify diseases, symptoms, and health conditions. These codes are critical for clinical documentation, public health reporting, insurance billing, and healthcare analytics. When a patient presents with pain in the right shoulder, the clinician must determine the underlying cause to assign the most accurate ICD-10 code.

The primary code used for pain in the right shoulder is M25.511 – Pain in right shoulder. This code falls under the broader category of 'Other joint disorders' and is specifically designated for pain localized to the right shoulder joint. However, depending on the clinical presentation, other more specific codes may be more appropriate. Let’s explore the most common ICD-10 codes related to right shoulder pain and the conditions they represent.

Common ICD-10 Codes for Right Shoulder Pain

M25.511 – Pain in Right Shoulder

This is the most frequently used ICD-10 code when a patient presents with localized pain in the right shoulder without a definitive diagnosis. It's a symptom code, meaning it identifies the presence of pain rather than the cause. It is appropriate for use when the provider is still investigating the origin of discomfort or when no structural abnormality is yet identified.

Examples of when M25.511 may be used include:

While M25.511 is widely used, it’s important to note that insurers may require a specific diagnosis over time. Therefore, further evaluation is often necessary to rule out or confirm conditions like rotator cuff injuries, bursitis, or arthritis.

M75.11 – Adhesive Capsulitis (Frozen Shoulder) of the Right Shoulder

Adhesive capsulitis, commonly known as frozen shoulder, is a condition characterized by stiffness, pain, and limited range of motion in the shoulder joint. It typically develops gradually and can last for months or even years. The right shoulder may be affected due to overuse, injury, or immobilization following surgery.

The ICD-10 code M75.11 specifically identifies adhesive capsulitis in the right shoulder. This code is more specific than M25.511 and should be used when the diagnosis is confirmed through physical examination, patient history, and possibly imaging. Frozen shoulder commonly affects individuals between the ages of 40 and 60 and is more prevalent in people with diabetes, thyroid disorders, or a history of shoulder immobilization.

M75.51 – Calcific Tendinitis of the Right Shoulder

Calcific tendinitis occurs when calcium deposits build up in the rotator cuff tendons, leading to inflammation and sharp shoulder pain. It is a common cause of shoulder pain, especially in adults aged 30 to 50, and may present with sudden, severe pain that limits shoulder movement.

The ICD-10 code M75.51 is used for calcific tendinitis affecting the right shoulder. Diagnosis is typically confirmed via X-ray or ultrasound, which reveals the calcium deposits. Treatment may involve physical therapy, corticosteroid injections, or in some cases, minor procedures to remove the deposits.

M75.811 – Other Specified Disorders of the Right Shoulder

When a shoulder condition doesn’t fit into a more specific category, providers may use M75.811. This code is used for other specified disorders of the right shoulder, such as subacromial impingement syndrome, bicipital tendinitis, or shoulder instability. It allows clinicians to document a diagnosis that is known but doesn’t have a unique ICD-10 code.

For example, if a patient presents with chronic impingement syndrome confirmed by MRI and physical examination, M75.811 may be used with appropriate clinical documentation.

S46.011A – Strain of Muscle, Fascia, and Tendons of the Right Shoulder, Initial Encounter

Acute shoulder injuries, such as those resulting from sports, lifting heavy objects, or sudden movements, may lead to muscle or tendon strain. The ICD-10 code S46.011A is used when the strain is in the right shoulder and is being addressed for the first time.

This code includes specificity for laterality (right side), type of injury (strain), and encounter type (initial). Follow-up visits may require the use of S46.011D (subsequent encounter) or S46.011S (sequela), depending on the stage of healing and complications.

M19.011 – Primary Osteoarthritis of the Right Shoulder

Osteoarthritis (OA) is a degenerative joint disease that can affect the glenohumeral joint of the shoulder. Although less common than knee or hip OA, it can cause chronic pain, stiffness, and reduced function. M19.011 is the ICD-10 code used for primary osteoarthritis of the right shoulder.

Primary osteoarthritis refers to cases where no underlying cause (such as trauma or disease) is identified. Secondary osteoarthritis, which results from prior injury or conditions like rheumatoid arthritis, would be coded differently—using M19.111.

M06.911 – Rheumatoid Arthritis, Unspecified, Right Shoulder

Rheumatoid arthritis (RA) is an autoimmune disorder that leads to chronic inflammation of the joints, including the shoulders. It often presents with symmetrical joint involvement, morning stiffness, and systemic symptoms. When RA affects the right shoulder and no further specification is documented, the code M06.911 is used.

More specific codes are available depending on the RA subtype or associated conditions, such as rheumatoid bursitis or nodule formation. Accurate diagnosis requires blood tests (e.g., rheumatoid factor, anti-CCP) and imaging.

S43.411A – Dislocation of the Right Shoulder Joint, Initial Encounter

Shoulder dislocation is a traumatic injury where the humeral head is forced out of the glenoid cavity. It is extremely painful and often requires immediate medical attention. The ICD-10 code S43.411A is used for a dislocation of the right shoulder joint during the initial treatment phase.

Recurrent dislocations, especially in younger patients, may require orthopedic referral. Follow-up care is coded with S43.411D, and any resulting complications (e.g., nerve injury, instability) may require additional codes.

Diagnostic Evaluation of Right Shoulder Pain

Accurate diagnosis of shoulder pain begins with a thorough patient history and physical examination. Clinicians should assess:

Physical examination includes range of motion testing, strength assessment, and special tests such as:

Imaging studies may be necessary to confirm the diagnosis:

Laboratory tests may be ordered if inflammatory arthritis is suspected, including ESR, CRP, rheumatoid factor, and anti-CCP antibodies.

Common Causes of Pain in the Right Shoulder

Shoulder pain can stem from a variety of sources. Understanding the root cause is key to selecting the correct ICD-10 code and treatment plan. Common causes include:

Rotator Cuff Injuries

The rotator cuff is a group of four muscles and tendons that stabilize the shoulder. Tears (partial or full-thickness), tendinitis, and degeneration are frequent causes of pain. ICD-10 codes like M75.11 (frozen shoulder), M75.51 (calcific tendinitis), or S46.011A (strain) may apply.

Bursitis

Subacromial bursitis occurs when the bursa—a fluid-filled sac that reduces friction—becomes inflamed. It often results from repetitive overhead activities and presents with pain during arm elevation. The code M75.811 may be used for bursitis when no more specific code applies.

Shoulder Impingement Syndrome

This condition occurs when the rotator cuff tendons are compressed during shoulder movement, leading to pain and inflammation. It’s commonly associated with poor posture or repetitive strain. M75.811 is the most appropriate code in many cases.

Osteoarthritis and Rheumatoid Arthritis

Joint degeneration or autoimmune inflammation can lead to chronic shoulder pain. M19.011 (primary OA) or M06.911 (RA) should be used based on the diagnosis.

Cervical Radiculopathy

Pain radiating from the neck due to nerve compression (e.g., C5-C6) can mimic shoulder pain. In such cases, cervical spine codes (e.g., M54.12 – radiculopathy in the cervical region) may be more accurate than shoulder-specific codes.

Referred Pain

Pain in the right shoulder may be referred from other organs, such as the gallbladder (e.g., cholecystitis) or diaphragm (e.g., after abdominal surgery). In these cases, the primary condition should be coded, not M25.511.

Treatment Approaches for Right Shoulder Pain

Treatment varies widely depending on the underlying diagnosis. A multidisciplinary approach often yields the best outcomes. Common interventions include:

Conservative Management

Surgical Interventions

When conservative treatments fail, surgery may be considered. Options include:

Post-surgical care requires accurate coding for follow-up visits, rehabilitation, and potential complications.

Importance of Accurate ICD-10 Coding

Proper ICD-10 coding is more than a billing requirement—it directly impacts patient care. Accurate codes ensure: