Billable FY2026 ICD-10-CM diagnosis code, shoulder region. What it covers, how to bill it cleanly, and what these patients sound like when they call.
Pain in the right shoulder, the symptom-level code for shoulder complaints before a structural diagnosis is established. Appropriate early; expected to give way to a specific diagnosis as imaging and examination clarify the picture.
| Code | Description |
|---|---|
| M25.512 | Pain in left shoulder |
| M25.519 | Pain in unspecified shoulder |
| M25.461 | Effusion, right knee |
| M25.462 | Effusion, left knee |
| M25.469 | Effusion, unspecified knee |
| M25.551 | Pain in right hip |
Right-shoulder pain is among the most common new-patient phone presentations in sports medicine. Intake that captures mechanism, duration, and overhead-work exposure speeds both scheduling and the eventual documentation trail.
ClinicFlow's voice AI runs this intake on every call for sports medicine practices: capturing the story, applying your routing rules, and booking the right visit type with the right surgeon. See voice AI for sports medicine practices or the Call Library for how each call type is handled.
M25.511 is the FY2026 ICD-10-CM code for pain in right shoulder. Pain in the right shoulder, the symptom-level code for shoulder complaints before a structural diagnosis is established.
Often at initial evaluation, but payer policies vary and many want conservative care documented first. Our prior authorization guide covers the imaging-approval patterns.
Yes. M25.511 appears in the official FY2026 ICD-10-CM code set (effective October 1, 2025). ICD-10-CM is public-domain CMS data; verify annually as codes are revised each fiscal year.
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