Left shoulder pain ICD 10 code
Left shoulder pain ICD 10 is a billing code used by physical therapists for shoulder pain, a common condition. Shoulder pain can arise from many underlying causes and often has a functional impact on patients including difficulty performing Activities for Daily Living, interference with job and parenting duties and reduced ability to participate in sport and leisure activities.
Because of the frequency with which physical therapists encounter shoulder pain, it is important to know how to utilize the left shoulder pain ICD 10 code. In this article we will discuss the left shoulder pain ICD 10 code and touch on other related codes that can help make your billing more specific and improve the likelihood of accurate and timely reimbursement from payer sources.
As a physical therapist, assessing shoulder pain helps to identify a likely health condition contributing to the pain as well as body structure and function impairments, and activity and participation limitations toward which the therapist can direct their treatment and goals.
Some common causes of acute and chronic shoulder pain include:
- Labral tear
- Arthritis
- AC joint separation
- Rotator cuff tear
- Rotator cuff strain
- Shoulder dislocation
- Post-surgical shoulder pain
- Shoulder fracture
- Adhesive capsulitis
- Bicipital tendinopathies
- Shoulder impingement
- Overuse injuries
Treatments for shoulder pain include medication, injections, arthroscopic and open surgical procedures and physical therapy. Physical therapy is often a first-line, conservative treatment approach for many of these conditions. Physical therapists apply a variety of treatment techniques to address pain in the shoulder.
These techniques include:
- Manual therapy: Soft tissue mobilization, myofascial release, ASTYM techniques and joint mobilization
- Modalities: Ultrasound, electrical stimulation, laser, cryotherapy, thermotherapy, dry needling
- Therapeutic exercise: Stretching, passive, active and active assist range of motion exercises, strength training, endurance and power exercises
- Neuromuscular re-education: Motor control, joint stabilization and muscle coordination training
- Functional training: Sport, work and activity-specific training to prepare the shoulder for return to prior levels of activity
- Patient education: Educating patients on how to modify activities, the importance of adherence to a home exercise program, strategies to manage pain and to reduce future injury
An introduction to ICD-10 Codes
If you, like many therapists, have some experience searching for and selecting left shoulder pain ICD 10 codes and similar codes but don’t have a good understanding of the who, what, when and why these codes are used, review this section for an ICD-10 code primer. Following this introduction we will discuss the left shoulder pain ICD10 code in more detail.
Who: All HIPAA-covered entities are required to submit ICD-10 codes if seeking reimbursement for services from an insurance company. This includes physical therapists.
What: The International Classification of Disease, 10th Revision (ICD-10) is a set of diagnosis, symptom, and procedure codes that physical therapists use daily in their practice. ICD-10 codes are alphanumeric codes. They begin with a letter and are always between three and seven characters with a decimal point placed after the third character. The more characters it has, the more specific it is.
Each code follows the following structure:
- Characters 1-3 indicate the category of the diagnosis
- Characters 4-6 indicate etiology, anatomic site, severity or other clinical detail
- Character 7 is an extension value, for example:
- A: initial encounter (anything related to care of the initial injury)
- D: subsequent encounter (anything related to the phase of routine care of the injury while the patient recovers–this usually refers to rehabilitation)
- S: sequela (other conditions that may result from the presence of the primary condition)
Note, for fracture care, there are several more extensions ( example: P, G, K, which signify malunion, delayed healing, or nonunion for a subsequent encounter).
When: ICD-10 codes must be submitted with relevant documentation whenever reimbursement is sought for covered services either by the healthcare entity itself or by a patient.
Why: While it may seem like an extra step in an already detailed process of documentation and billing, ICD-10 codes are required for a specific reason. Not only do they identify a medical diagnosis, but perhaps more importantly, they help insurance companies understand why the care you are providing is medically necessary and therefore, reimbursable.
Start My Free Trial
Left shoulder pain ICD 10 codes
What is the ICD-10 code for left shoulder pain?
Left shoulder pain ICD 10 code, M25.512 is used in situations where the patient is presenting with discomfort or pain in the shoulder region lasting more than 3 months (chronic) or less than 3 months (acute).
The left shoulder pain ICD 10 code can be used to account for both shoulder and AC joint pain. This code is considered specific enough for billing/reimbursement purposes but given that it fails to identify any health condition associated with the pain, alternative codes may be available that more accurately describe your patient’s condition.
Let’s look at some examples of more specific left shoulder pain ICD 10 codes to give you an idea of what to search for when documenting.
Shoulder pain ICD 10 codes | Description |
|---|---|
Strain of the muscle(s) and tendon(s) of the rotator cuff of left shoulder, initial encounter | |
Sprain of the left acromioclavicular joint, subsequent encounter | |
Impingement syndrome of the left shoulder | |
Bicipital tendinitis, left shoulder | |
Used to declare aftercare after joint (in this case shoulder) replacement surgery and used with code Z96.612 for presence of left artificial shoulder joint | |
Used to denote an encounter for other specified surgical aftercare which includes aftercare for musculoskeletal system surgery |
When it comes to selecting the correct left shoulder pain ICD 10 codes, the Centers for Medicare and Medicaid Services publish an updated list of codes each year to go into effect October 1 and remain in effect until September 30 of the following year. Sites like ICD10 Data can also be helpful in identifying code changes once they update their list as announced on their homepage.
Additional code considerations
In addition to the primary code selections, place of occurrence codes (Y92) and external cause codes (V00-Y99) can be used to further increase specificity for billing. These codes are often used only during the initial evaluation.
Below is an example for each type of code as it relates to left shoulder pain due to fall from ladder on construction site:
- Y92.6: Building [any] under construction as the place of occurrence of the external cause
- W11: Fall on and from ladder
Resources
While successfully treating a patient with left shoulder pain and billing using left shoulder pain ICD 10 codes may require a lot of hard work on your part, managing the billing, coding, patient scheduling and documentation doesn’t need to be.
Theraplatform is an all-in-one EHR, practice management and teletherapy solution that allows you to focus more on patient care. With a 30-day free trial, you have the opportunity to experience Theraplatform for yourself with no credit card required. Cancel anytime.
More resources
- Therapy resources and worksheets
- Therapy private practice courses
- Ultimate teletherapy ebook
- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
