What does ICD-10-CM code M25.519 mean?
M25.519 represents Pain in unspecified shoulder. This musculoskeletal condition falls under Chapter 13 (Diseases of the Musculoskeletal System) and is among the most common reasons for outpatient visits. Coders frequently reference this code as icd 10 code for shoulder pain, icd 10 for left shoulder pain, icd 10 for shoulder pain, or icd 10 left shoulder pain.
Code category and hierarchy
- Chapter: 13 – Diseases of the Musculoskeletal System (M00-M99)
- Category: M25
- Code: M25.519 – Pain in unspecified shoulder
Guideline notes and coding considerations
Specificity Warning
M25.519 is an unspecified code. Query the provider for greater specificity when documentation suggests a more precise code is available. Using unspecified codes when specific codes exist may trigger audits.
- Specificity: Assign M25.519 only when documentation supports this specific diagnosis.
Learn the underlying rules in the ICD-10 Coding Guidelines, Laterality Coding Rules.
Documentation tips (what coders should confirm)
- Verify the clinical documentation supports the use of M25.519
- Query the provider for greater specificity if clinical details suggest a more precise code
When NOT to use M25.519
Do not assign M25.519 when the clinical scenario involves: when documentation provides enough detail for a more specific code. Review excludes notes and assign the most specific code supported by documentation.
Audit risk
M25.519 is an unspecified code. Payers and auditors may flag claims with unspecified codes when the medical record contains sufficient detail for a more precise diagnosis. Query the provider for specificity before submitting.
More specific alternatives
Consider these more specific codes when documentation supports them: M25.511 (Pain in right shoulder), M25.512 (Pain in left shoulder), M25.561 (Pain in right knee).
Validate M25.519 Against ICD 10 CM Coding Guidelines
Check this code against official guidelines for conflicts and compliance issues.
Related ICD-10 codes
Frequently Asked Questions
The ICD-10-CM code for icd 10 code for shoulder pain is M25.519, which represents pain in unspecified shoulder. This code is also commonly referenced as icd 10 for left shoulder pain, icd 10 for shoulder pain, icd 10 left shoulder pain. Verify this code using the ICD Code Auditor to ensure guideline compliance.
Yes. M25.519 is an active ICD-10-CM diagnosis code used to classify pain in unspecified shoulder for clinical documentation, reporting, and medical billing purposes.
Use the ICD Code Auditor to check M25.519 against official ICD-10-CM coding guidelines. The tool validates by fiscal year and patient gender to identify potential conflicts.
M25.519 should be used only when clinical documentation does not provide enough detail for a more specific code. Always query the provider when documentation suggests greater specificity is available, as unspecified codes may trigger audits and impact risk adjustment.
Documentation should clearly describe the clinical condition represented by M25.519 (Pain in unspecified shoulder). Include relevant clinical findings, diagnostic test results, provider assessment, and the treatment plan. The diagnosis must be supported by the medical record and not based solely on lab results without clinical interpretation.
Sources
Reviewed by: Certified ICD-10 Coding & Risk Adjustment Specialist
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