August 26, 2025
ICD-10 code M25.511 is used to describe maximum situations of pain, especially in the right shoulder. Healthcare providers use this code to document patient symptoms when pain exists, but the exact underlying cause has not yet been identified.
Correct use of this code ensures accurate medical documentation, smooth billing, and proper insurance claim processing.
The M25.511 diagnosis code refers to pain localized in the right shoulder without specifying the root cause. Physicians apply this ICD-10 code when a patient complains of shoulder pain. Still, diagnostic tests have not confirmed whether it is due to a rotator cuff tear, arthritis, bursitis, or other shoulder conditions.
This code helps establish the patient’s condition in early visits, before a more specific diagnosis is available.
Here’s a basic association of right shoulder pain vs. rotator cuff tear codes in ICD-10:
ICD-10 Code | Meaning | When It’s Appropriate | Related Options |
M25.511 | Pain in the right shoulder | Used when the patient has shoulder pain without a confirmed diagnosis | M25.512 (Left shoulder pain), M25.519 (Unspecified shoulder pain) |
M75.101 | Rotator cuff tear – right shoulder (unspecified type) | Applied when the pain is confirmed to be from a rotator cuff injury | M75.111 (Incomplete tear, right shoulder) |
Fill out the form below and we’ll contact you shortly.
Healthcare providers apply this code in situations such as:
Once tests confirm the cause (like arthritis, bursitis, or rotator cuff tears), the ICD-10 code must be updated to reflect the accurate condition
Using the correct code matters because insurers require clinical accuracy for claim approvals.
Right shoulder discomfort can come from different conditions, including:
Correct ICD-10 medical coding ensures that the medical record reflects whether the pain is just a symptom (M25.511) or tied to a diagnosed disorder (e.g., M75.101).
Tip: Always update the diagnosis code as soon as a clearer condition is identified.
ICD-10 code M25.511 is used to record right shoulder pain when the exact cause has not yet been identified. It allows providers to capture symptoms accurately, supports correct billing, and ensures insurance compliance. Once the underlying issue, such as a rotator cuff tear, bursitis, or arthritis, is identified, the diagnosis should be updated to a more specific ICD-10 code.
By applying the M25.511 diagnosis code correctly, clinicians maintain accurate medical records while giving patients a clear path toward diagnosis and treatment.
Need help with musculoskeletal and orthopedic billing?
Contact Cures Medical Billing for expert support on ICD-10 codes like M25.511 (Right Shoulder Pain), M25.512, and M75.101. We ensure your claims are coded correctly — so you get reimbursed fully and on time.
It refers to pain in the right shoulder without identifying the underlying cause.
Yes, but if the pain is clearly due to a chronic condition such as arthritis, the specific ICD-10 code should be reported instead.
That would be M25.519.
If the pain is caused by a chronic issue like arthritis, use the exact code for that condition instead of M25.511.
Do not use it when the exact cause (fracture, infection, rotator cuff tear) is already confirmed.
Discover Cures Medical Billing Services Across Different States
FL
NY
ML
CO
NJ
AZ
TX
CA
WA
We are a team of national medical billing service experts based in Astoria, NY, committed to providing ongoing value to our customers. We leverage technology and implement best practices to provide high-quality and cost-efficient medical billing solutions from domestic locations, enabling customers to achieve their business goals. Cures Medical Billing is the best option for any medical billing needs.
Medical billing around Astoria, NY, and beyond is our core competency and our specialists will efficiently manage all your billing needs. Our medical billing specialists have over 12 Plus years of experience with all security technologies to ensure data integrity for our customers. Using our medical billing service, anyone can make their medical billing task less resource-consuming.
Discover unparalleled efficiency and precision in healthcare financial management with Cures Medical Billing Solutions.
© 2024 Created Cures Medical Billing Solutions, All copyrights Reserved
