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M25.419

Billable

Effusion, unspecified shoulder

This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).

What This Code Means

Fluid buildup in the shoulder joint when the specific shoulder is not specified. This can cause swelling, stiffness, and discomfort in the shoulder area.

Coding Tips

  • Use this code only when documentation does not specify right or left shoulder; if laterality is documented, use M25.411 (right) or M25.412 (left) instead.
  • Effusion may result from trauma, arthritis, or inflammatory conditions; review clinical notes to determine if a more specific underlying diagnosis should be coded.

Code Hierarchy

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