Left shoulder pain, categorized as arthralgia of the shoulder joint, refers to discomfort, aching, or soreness localized to the left glenohumeral, acromioclavicular, or sternoclavicular regions. Under 2025 ICD-10-CM guidelines, clinical documentation must specify laterality to ensure the highest level of coding specificity. The code M25.512 is the definitive billable code for pain specific to the left shoulder when a more specific underlying diagnosis, such as a rotator cuff tear or bursitis, has not yet been established.
- Primary ICD-10 Code for Left Shoulder Pain
- ICD-10 Code: M25.512
- When to Use M25.512
- When Not to Use M25.512
- Importance of Laterality in ICD-10 Coding
- Related ICD-10 Codes for Shoulder Pain
- Services Commonly Covered Under M25.512
- What is the ICD-10 code for left shoulder pain?
- Is M25.512 billable?
- Can M25.512 be used for chronic shoulder pain?
- What if the provider does not specify left or right?
- Should pain codes be used with a confirmed diagnosis?
- Does M25.512 require an additional diagnosis code?
Primary ICD-10 Code for Left Shoulder Pain
ICD-10 Code: M25.512
Description: Pain in left shoulder
This is the most commonly used ICD-10 code when a patient presents with pain localized to the left shoulder and no further specific diagnosis is documented.
When to Use M25.512
Use this code when:
- The provider documents pain specifically in the left shoulder
- No confirmed underlying condition is identified at the time of the visit
- The visit is focused on evaluation or symptom management
When Not to Use M25.512
Do not use this code if:
- The pain is due to a confirmed injury, fracture, or dislocation
- A more specific diagnosis such as arthritis or rotator cuff tear is documented
- Laterality is unclear or undocumented
Importance of Laterality in ICD-10 Coding
ICD-10 requires precise laterality to be documented. Left, right, and unspecified sites are coded differently. Using the wrong side can result in claim rejections or payer audits.
Examples:
- M25.511 Pain in right shoulder
- M25.512 Pain in left shoulder
- M25.519 Pain in unspecified shoulder
Always confirm that the provider clearly documents left shoulder involvement before selecting M25.512.
Related ICD-10 Codes for Shoulder Pain
In many cases, shoulder pain is a symptom of an underlying condition. When documented, coders should assign a more specific diagnosis code instead of a general pain code.
Common Related Codes
- M75.102 Rotator cuff tear or rupture, left shoulder
- M75.52 Bursitis of left shoulder
- M19.012 Primary osteoarthritis, left shoulder
- M75.02 Adhesive capsulitis of left shoulder
- S46.012A Strain of muscle and tendon of rotator cuff, left shoulder, initial encounter
Using a more specific code improves claim accuracy and supports medical necessity.
Acute vs Chronic Left Shoulder Pain Coding
Providers may document shoulder pain as acute or chronic. While M25.512 does not differentiate between the two, documentation still matters.
- Acute pain typically lasts less than 3 months
- Chronic pain lasts longer than 3 months and may require additional evaluation
If chronic pain is documented, coders may need to assign an additional chronic pain code such as G89.29 when supported by the medical record.
Services Commonly Covered Under M25.512
The ICD-10 code for left shoulder pain may support coverage for several services when medically necessary.
Commonly billed services include:
- Office or outpatient evaluation and management visits
- Diagnostic imaging such as X-rays or MRI
- Physical therapy evaluations
- Pain management services
- Injections when appropriate
- Follow-up visits
Coverage depends on payer policies, documentation quality, and clinical justification.
ICD-10 Coding Guidelines and Notes
Key coding rules for M25.512 include:
- Do not code pain separately if it is integral to a confirmed diagnosis
- Assign additional codes when an underlying condition is identified
- Use the most specific code supported by documentation
- Avoid unspecified codes when laterality is known
These guidelines help ensure compliance with payer and CMS standards.
Coding History and Validity
- ICD-10 code M25.512 has been in use since ICD-10 implementation
- The code remains valid and billable for the current ICD-10 fiscal year
- No major description changes have been made in recent updates
Always verify code validity annually during ICD-10 updates.
FAQs
What is the ICD-10 code for left shoulder pain?
The ICD-10 code for left shoulder pain is M25.512.
Is M25.512 billable?
Yes, M25.512 is a billable and valid diagnosis code for the current ICD-10 fiscal year.
Can M25.512 be used for chronic shoulder pain?
Yes, but an additional chronic pain code may be required if documented.
What if the provider does not specify left or right?
Use M25.519 for unspecified shoulder pain only when laterality is not documented.
Should pain codes be used with a confirmed diagnosis?
No. Pain codes should not be reported when the pain is inherent to a confirmed condition.
Does M25.512 require an additional diagnosis code?
It depends on documentation. If an underlying condition exists, that condition should be coded instead or in addition.
Final Thoughts
The ICD-10 code for left shoulder pain, M25.512, is straightforward but requires careful attention to documentation and laterality. Medical billers and coders must always review provider notes thoroughly to ensure accurate code selection. Proper coding not only supports compliance but also plays a major role in improving revenue cycle outcomes and reducing claim delays.
