M25.519: Pain in unspecified shoulder

The ICD-10-CM code for shoulder pain when no diagnosis explains the pain and no note anywhere in the medical record identifies which shoulder hurts.

Billable

FY2027

TABLE OF CONTENTS

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At a glance

Code Family

M25.51: Pain in shoulder.

DRG Grouping

MS-DRG 555 or 556, Signs and symptoms of musculoskeletal system and connective tissue, when M25.519 is the principal diagnosis under the FY2027 MS-DRG v44 grouper.

HCC Mapping (v28)

None. M25.519 is absent from the CMS-HCC v28 diagnosis crosswalk.

Family Specificity

Three billable child codes, split only by side. M25.519 is the code for a shoulder the record never identifies.

Billable

Yes. M25.519 is a complete code in the FY2027 billable code list.

Effective Date

Valid in the FY2026 code set and unchanged in the FY2027 update.

Which M25.51 code do I assign?

Subcategory M25.51 has three codes and one axis: the side of the painful shoulder. Guideline I.B.13 says codes for the unspecified side should rarely be used. M25.519 waits until the whole record has been read and a query is not possible.

When documentation says…

Code

Shoulder pain, no side in any note, provider unavailable for query

M25.519

Pain in a shoulder the record never identifies. The full record has been reviewed and the side cannot be clarified.

Provider writes shoulder pain, therapist documents the right shoulder

M25.511

Guideline I.B.13 allows the side to come from another clinician's documentation when the provider omits it. M25.519 does not apply.

Left shoulder pain, no diagnosis established

M25.512

Pain in the left shoulder with no confirmed cause. Any note naming the left shoulder supports it.

Pain in both shoulders

M25.511

Report M25.511 with M25.512. Subcategory M25.51 has no bilateral code. Guideline I.B.13 directs separate codes for the left and right side.

Nontraumatic rotator cuff tear, side not stated

M75.100

The Index sends Tear, rotator cuff (nontraumatic) to the M75.10 codes. A confirmed diagnosis that explains the pain replaces M25.519.

Frozen shoulder, side not stated

M75.00

Frozen shoulder is an inclusion term at M75.0, adhesive capsulitis of shoulder. The confirmed diagnosis replaces the pain code.

Shoulder sprain from a recent fall, side not stated

S43.409A

The Index sends Sprain, shoulder joint to the S43.40 codes. A current injury is coded from Chapter 19 with a seventh character for the encounter.

Tabular notes

EXCLUDES1

M25.519 carries no Excludes1 note. None sits on M25.51, M25.5, category M25, block M20-M25 or Chapter 13 either.

EXCLUDES2

At M25.5, pain in joint: pain in hand (M79.64-), pain in fingers (M79.64-), pain in foot (M79.67-), pain in limb (M79.6-) and pain in toes (the M79.67 codes).

At category M25: abnormality of gait and mobility (R26.-), acquired deformities of limb (M20-M21), calcification of bursa (M71.4-), calcification of shoulder (joint) (M75.3), calcification of tendon (M65.2-), difficulty in walking (R26.2) and temporomandibular joint disorder (the M26.6 codes).

At block M20-M25: joints of the spine (M40-M54).

At Chapter 13, among others: injury, poisoning and certain other consequences of external causes (S00-T88), and symptoms, signs and abnormal clinical and laboratory findings (R00-R94).

An Excludes2 note means the excluded condition is not part of this code. A patient may have both conditions. Both may be reported when both are documented.

USE ADDITIONAL

M25.519 carries no use additional code instruction at the code, subcategory or category level. Chapter 13 carries a general note to use an external cause code following the musculoskeletal code, if applicable, to identify the cause.

CODE FIRST

M25.519 carries no code first or code also instruction at any level.

FY2027: EFFECTIVE 1 OCTOBER 2026

The FY2027 codes addenda add, delete or revise no code in subcategory M25.51 or category M75. M25.519 remains billable in the FY2027 code set.

The FY2027 Index still routes Pain, shoulder and Pain, joint, shoulder to subcategory M25.51, where a sixth character identifies the side.

Operational & financial impact

Why specificity matters beyond the chart: risk adjustment, DRG assignment and denial exposure all follow from which code is selected.

CMS-HCC v28 (PY2024+)

None. No code in category M25 appears in the CMS-HCC v28 diagnosis crosswalk.

The shoulder lesion codes in category M75 and the primary shoulder osteoarthritis codes in subcategory M19.01 are also absent from that crosswalk.

MS-DRG v44 (FY2027)

MS-DRG 555: Signs and symptoms of musculoskeletal system and connective tissue with MCC.

MS-DRG 556: Signs and symptoms of musculoskeletal system and connective tissue without MCC.

M25.519 groups to this pair as principal diagnosis in MDC 08, per the CMS MS-DRG v44.0 Definitions Manual, Appendix B.

Medicare and commercial payers

M25.519 carries no payer restriction in the tabular. Coverage of shoulder imaging, injections and therapy follows the policy for the service billed.

WHERE SPECIFICITY IS LOST

Reporting M25.519 when a nursing, therapy or imaging note names the side ignores documentation that Guideline I.B.13 allows the coder to use.

Reporting M25.519 once for pain in both shoulders drops a side from the claim. The correct report is M25.511 plus M25.512.

When the record conflicts on the side, Guideline I.B.13 calls for a provider query rather than the unspecified code.

SEVERITY DESIGNATION (MS-DRG V44, FY2027)

M25.519 is on neither list. It carries no CC or MCC designation as a secondary diagnosis.

No code in subcategory M25.51 carries a CC or MCC designation.

Per Table 6I (Complete MCC List) and Table 6J (Complete CC List) of the FY2027 IPPS final rule (CMS-1849-F), MS-DRG v44.

Documentation checklist to support M25.519

Chart elements that support code selection and reduce specificity-driven denials.

A search of the full record for the side, including nursing, therapy, radiology and procedure notes.

Whether one shoulder or both shoulders hurt. Pain in both shoulders is coded M25.511 plus M25.512.

Any conflict between notes on the side, with the provider query and its answer.

The site of the pain: the shoulder joint itself rather than the upper arm, which is coded to the M79.62 codes.

The working or confirmed diagnosis, if any. A confirmed rotator cuff tear, adhesive capsulitis, impingement, bursitis or osteoarthritis replaces the pain code.

Any recent injury and its mechanism, to support an injury code and an external cause code where applicable.

Whether the provider attributes the pain to the neck. Cervical radiculopathy is coded M54.12 rather than a shoulder pain code.

Whether the provider calls the pain chronic, which supports G89.29 as an additional code.

For outpatient encounters, a confirmed diagnosis only. A suspected or probable cause stays at the symptom code under Section IV.H.

FAQ

Is M25.519 a billable ICD-10-CM code?

Yes. M25.519 is a six-character code with no further characters to add. It appears in the FY2027 billable code list. The FY2027 codes addenda leave it unchanged.

When is M25.519 the right shoulder pain code?

Only when the record never identifies the side and the side cannot be clarified. Guideline I.B.13 says codes for the unspecified side should rarely be used. It gives insufficient documentation with no possible clarification as the example.

Can a nurse or physical therapist document which shoulder is affected?

Yes. Guideline I.B.13 allows code assignment for the affected side to be based on documentation from other clinicians when the provider does not document laterality. Guideline I.B.14 lists laterality among those exceptions.

Is M25.519 the code for pain in both shoulders?

No. M25.519 means the side is unknown, not that both sides are affected. Subcategory M25.51 has no bilateral code. Guideline I.B.13 directs separate codes for each side. Pain in both shoulders is reported as M25.511 and M25.512.

When does a rotator cuff or other shoulder diagnosis replace M25.519?

As soon as the provider confirms it. Guideline I.B.4 accepts symptom codes only when a related definitive diagnosis has not been established. Category M75 holds rotator cuff tears, adhesive capsulitis, impingement, bicipital tendinitis and bursitis of the shoulder.

Does M25.519 map to a CMS-HCC under v28?

No. M25.519 is absent from the CMS-HCC v28 diagnosis crosswalk. No code in category M25 appears there. The shoulder lesion codes in category M75 are absent as well.

How is unspecified shoulder pain sequenced with chronic pain?

When the encounter is for pain control or pain management, Section I.C.6.b.1 lists the G89 code first and M25.519 second. For any other reason, with no confirmed diagnosis, M25.519 comes first and G89.29 follows.

Is M25.519 handled differently in inpatient and outpatient settings?

Outpatient coders report M25.519 until a cause is confirmed, because Section IV.H bars coding a probable or suspected diagnosis. Inpatient coders code an uncertain diagnosis documented at discharge as established under Section II.H. As principal diagnosis, M25.519 groups to MS-DRG 555 or 556.

Related codes

Codes in the same family as M25.519. Only codes with a published page render as links.

Sibling codes in the M25.51 family

M25.511: Pain in right shoulder.
M25.512: Pain in left shoulder.

Additional codes to consider

Codes outside the M25.51 family considered alongside M25.519.

Companion: code alongside when documented

G89.29: Other chronic pain, when the provider documents the shoulder pain as chronic.
M79.629: Pain in unspecified upper arm, when upper arm pain is documented separately from the shoulder joint pain.

Consider instead

M25.511: Pain in right shoulder, when any note in the record names the right shoulder.
M25.512: Pain in left shoulder, when any note in the record names the left shoulder.
M75.100: Unspecified rotator cuff tear or rupture of unspecified shoulder, not specified as traumatic.
M75.00: Adhesive capsulitis of unspecified shoulder, when frozen shoulder is documented.
M75.40: Impingement syndrome of unspecified shoulder.
M75.50: Bursitis of unspecified shoulder.
M75.20: Bicipital tendinitis, unspecified shoulder.
M19.019: Primary osteoarthritis, unspecified shoulder.
S43.409A: Unspecified sprain of unspecified shoulder joint, initial encounter.
S46.019A: Strain of muscle(s) and tendon(s) of the rotator cuff of unspecified shoulder, initial encounter, when a traumatic rotator cuff tear is documented.
M54.12: Radiculopathy, cervical region, when the provider attributes the shoulder pain to cervical radiculopathy.
M25.50: Pain in unspecified joint, when the record does not name the joint.

Sources

All claims on this page derive from government and professional-standards sources.

National Center for Health Statistics. (2026). International classification of diseases, tenth revision, clinical modification (ICD-10-CM) FY2027 files. https://www.cdc.gov/nchs/icd/icd-10-cm/files.html
Centers for Medicare & Medicaid Services and National Center for Health Statistics. (2026). ICD-10-CM official guidelines for coding and reporting FY2027. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2027/ICD-10-CM-October-1-2026-FY27-Guidelines.pdf
Centers for Medicare & Medicaid Services. (2025). 2026 model software/ICD-10 mappings. https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment/2026-model-software-icd-10-mappings
Centers for Medicare & Medicaid Services. (2026). MS-DRG classifications and software, version 44. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software