ICD-10 Coding for Hip Pain Unspecified(M25.559)
Complete ICD-10-CM coding and documentation guide for Hip Pain Unspecified. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hip Pain Unspecified
M25.5Primary Range
Pain in joint
This range includes codes for pain in joints, including the hip, with specific codes for laterality and unspecified locations.
Key Information: ICD-10 code for unspecified hip pain
Essential facts and insights about Hip Pain Unspecified
Primary ICD-10-CM Code for hip pain unspecified
Decision Criteria
clinical Criteria
- Pain in hip without clear lateralization
documentation Criteria
- Absence of specific laterality in clinical notes
Applicable To
- Diffuse hip pain without specified laterality
Clinical Validation Requirements
- Limited hip range of motion on exam
- Negative X-ray/MRI for specific pathology
- Documented exclusion of trauma
Code-Specific Risks
- Overuse when laterality is known
- Potential for reduced reimbursement if more specific codes are applicable
Coding Notes
- Ensure documentation specifies lack of laterality to justify use of unspecified code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other chronic pain
G89.29Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hip Pain Unspecified to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M25.559.
Impact
Clinical: Inadequate treatment planning, Regulatory: Non-compliance with chronic pain coding, Financial: Potential for denied claims
Mitigation Strategy
Always document pain duration, Review chronic pain coding guidelines
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Use M25.551 or M25.552 if laterality is known.
Impact
High risk of audit if unspecified codes are overused.
Mitigation Strategy
Use specific codes when possible and document reasons for unspecified use.
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 Hip Pain Unspecified, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hip Pain Unspecified
Use these documentation templates to ensure complete and accurate documentation for Hip Pain Unspecified. These templates include all required elements for proper coding and billing.
Chronic hip pain evaluation
Specialty: Primary CareRequired Elements
- Pain duration
- Aggravating and alleviating factors
- Physical exam findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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