Other bursal cyst, unspecified shoulder

This code signifies the presence of a fluid-filled sac (bursal cyst) in the shoulder region, without further specification of its exact location within the shoulder. It indicates a non-inflammatory, benign swelling or lesion arising from a bursa. The "unspecified" nature means the laterality (right or left) of the affected shoulder is not documented.

Use this code when documentation clearly indicates a bursal cyst of the shoulder, but the specific bursa involved (e.g., subacromial, subdeltoid) is not identified, and the affected side is not specified. This code is appropriate when the provider's notes simply state "shoulder bursal cyst" without further detail.

• Avoid using this code if the laterality (right or left shoulder) is documented; instead, choose a more specific code from the M71.31- series.
• If the specific bursa is identified (e.g., subacromial bursal cyst), use a more precise code from the M71.2- or M71.3- series.
• Ensure documentation supports the "unspecified" nature; if laterality or specific bursa is known, query the provider for clarification to allow for more specific coding.