ICD Code M25.511

ICD code M25.511 is used to specify a diagnosis of pain in the right shoulder. This code is part of the International Classification of Diseases, 10th Revision (ICD-10), which is used by healthcare providers to document and code symptoms, diseases, and conditions for billing and record-keeping purposes. The code M25.511 helps ensure accurate communication and processing of healthcare claims related to shoulder pain, facilitating effective treatment and reimbursement processes.

1. Localized Pain: The patient reports pain specifically in the right shoulder area, without radiating to other parts of the body.

2. Onset and Duration: The pain has been present for a specific duration, whether acute or chronic, and the onset can be sudden or gradual.

3. Pain Characteristics: The pain may be described as sharp, dull, throbbing, or aching, and can vary in intensity from mild to severe.

4. Impact on Functionality: The pain affects the patient's ability to perform daily activities, such as lifting, reaching, or carrying objects.

5. Associated Symptoms: There may be accompanying symptoms such as swelling, stiffness, or reduced range of motion in the right shoulder.

6. Exclusion of Other Causes: Other potential causes of shoulder pain, such as referred pain from cardiac or abdominal issues, have been ruled out through clinical evaluation.

7. Physical Examination Findings: Clinical examination reveals tenderness, limited movement, or other signs consistent with pain localized to the right shoulder.

8. Imaging and Diagnostic Tests: Imaging studies, such as X-rays or MRIs, may be used to confirm the presence of conditions that could cause pain in the right shoulder, such as arthritis or rotator cuff injuries.

9. Patient History: The patient's medical history, including any previous injuries or surgeries to the right shoulder, is considered to determine the cause of the pain.

10. Response to Treatment: The patient's response to initial treatments, such as pain relief medications or physical therapy, is monitored to assess the persistence or resolution of symptoms.

For the ICD code M25.511, which indicates pain in the right shoulder, the relevant CPT codes that may be applicable for treatment include:

1. 20610 - Arthrocentesis, aspiration, and/or injection into a major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa); without ultrasound guidance.

2. 20611 - Arthrocentesis, aspiration, and/or injection into a major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa); with ultrasound guidance, with permanent recording and reporting.

3. 23130 - Acromioplasty or acromionectomy, partial, with or without coracoacromial ligament release.

4. 23410 - Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; acute.

5. 23412 - Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; chronic.

6. 29806 - Arthroscopy, shoulder, surgical; capsulorrhaphy.

7. 29807 - Arthroscopy, shoulder, surgical; repair of SLAP lesion.

8. 29826 - Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release.

9. 97110 - Therapeutic exercises to develop strength and endurance, range of motion, and flexibility (each 15 minutes).

10. 97140 - Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes.

These CPT codes are examples of procedures and treatments that might be considered for addressing pain in the right shoulder, as indicated by ICD code M25.511. The selection of specific CPT codes should be based on the individual patient's condition and the healthcare provider's clinical judgment.

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