At the top of page 56 of the ICD-10-CM ebook, there appears to be a discrepancy between the sentence just below the header and the example in the blue box. The sentence says signs/symptoms not routinely associated with other definite diagnoses SHOULD be reported. Applying that to the example, I would have reported both the URI and the shoulder pain, but the example states that the URI should NOT be reported. Which is correct? See attached screenshot.
There isn't a discrepancy in the document you uploaded.
Maybe this will help:
Codes for signs and symptoms that are not routinely associated with other definite diagnoses should be reported.
Meaning: "You should code signs and symptoms that are not routinely associated with other definite diagnoses."
Using the example in the box from your page:
If a patient's symptoms are routinely reported with one of the patient's definitive diagnoses, then you
should not report that sign or symptom separately.
In the example box from your page, the runny nose is an example of that. The patient has an upper respiratory infection (URI) - you'd code the upper respiratory infection and you would NOT code the symptom code for runny nose. A runny nose is a common symptom of an upper respiratory infection.
If a sign or symptom is not routinely reported with one of the patient's definitive diagnoses, then you
should report that sign or symptom separately.
In the example from your page, the shoulder pain is an example of that. The patient has an upper respiratory infection and shoulder pain, so you'd code both the upper respiratory infection and the shoulder pain.
The shoulder pain would be coded separately from the URI, because shoulder pain is not a common symptom of an upper respiratory infection.