ICD-10 Coding for Gluteal Pain(M76.01, G57.01)
Complete ICD-10-CM coding and documentation guide for Gluteal Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Gluteal Pain
M76.0-M76.1Primary Range
Gluteal tendinopathy
Primary range for tendinopathy affecting the gluteal region.
G57.0xPrimary Range
Piriformis syndrome
Primary range for nerve entrapment syndromes affecting the gluteal region.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M76.01 | Gluteal tendinopathy, right side | Use when imaging confirms tendinopathy on the right side. |
|
| G57.01 | Piriformis syndrome, right side | Use when clinical tests confirm piriformis syndrome on the right side. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for gluteal pain
Essential facts and insights about Gluteal Pain
Primary ICD-10-CM Codes for gluteal pain
Decision Criteria
clinical Criteria
- MRI confirms tendinopathy
documentation Criteria
- Documented tenderness over greater trochanter
Applicable To
- Right gluteus medius tendinopathy
Excludes
- Piriformis syndrome (G57.01)
Clinical Validation Requirements
- MRI showing hyperintensity in gluteus medius tendon
- Pain on resisted abduction
Code-Specific Risks
- Misidentifying tendinopathy as general hip pain
Coding Notes
- Ensure documentation specifies tendon involvement.
G57.01 - Piriformis syndrome, right side
Use when clinical tests confirm piriformis syndrome on the right side.
Applicable To
- Right piriformis muscle syndrome
Excludes
- Gluteal tendinopathy (M76.01)
Clinical Validation Requirements
- Positive FAIR test
- EMG showing delayed H-reflex
Coding Notes
Document specific tests confirming nerve involvement.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Gluteal Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M76.01.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Increases risk of audit issues., Financial: Potential for denied claims.
Mitigation Strategy
Use specific anatomical terms, Include imaging and test results
Impact
Reimbursement: Incorrect coding can lead to reduced reimbursement., Compliance: May result in compliance issues during audits., Data Quality: Affects the accuracy of clinical data.
Mitigation Strategy
Use M76.0x + M25.55x with laterality
Impact
Risk of audits due to non-specific coding of hip pain.
Mitigation Strategy
Use detailed documentation and specific codes.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Gluteal Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Gluteal Pain
Use these documentation templates to ensure complete and accurate documentation for Gluteal Pain. These templates include all required elements for proper coding and billing.
Lateral hip pain with imaging confirmation
Specialty: OrthopedicsRequired Elements
- Location and character of pain
- Imaging findings
- Physical exam results
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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