M25.111
M25.111 — Fistula, right shoulder
Billable / specific codeICD-10-CMright
M25.111 is a billable, specific ICD-10-CM code for fistula, right shoulder. It is valid for submission on a claim.
Risk adjustment
M25.111 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
M25.111 is named in 9 Medicare coverage policies — 3 listing it as supporting medical necessity, and 6 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A58893Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A59374Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A59434Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
Related codes at this level
Codes that share M25.11. If M25.111 is not quite right, the correct code is usually one of these.
Questions about M25.111
- Is M25.111 a billable ICD-10-CM code?
- Yes. M25.111 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M25.111 sit in the tabular list?
- Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Other joint disorders (M20-M25).