ICD-10 Coding for Painful Hip(M25.551, M25.552, M16.0)
Complete ICD-10-CM coding and documentation guide for Painful Hip. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Painful Hip
M25.55Primary Range
Pain in hip
This range covers codes for pain specifically located in the hip, which is the primary concern for painful hip conditions.
Other chronic pain
This code is used for chronic pain management, often in conjunction with site-specific pain codes.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| M25.551 | Pain in right hip | Use when the patient presents with pain specifically in the right hip without a confirmed underlying condition like osteoarthritis. |
|
| M25.552 | Pain in left hip | Use when the patient presents with pain specifically in the left hip without a confirmed underlying condition like osteoarthritis. |
|
| M16.0 | Bilateral primary osteoarthritis of hip | Use when bilateral osteoarthritis is confirmed via imaging. |
|
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 painful hip
Essential facts and insights about Painful Hip
Primary ICD-10-CM Codes for painful hip
Decision Criteria
clinical Criteria
- Pain localized to the right hip without other specific diagnosis
documentation Criteria
- Laterality must be specified as right
Applicable To
- Right hip pain
Excludes
- Osteoarthritis of right hip (M16.11)
Clinical Validation Requirements
- Patient reports pain localized to the right hip
- Physical examination confirms tenderness in the right hip area
Code-Specific Risks
- Ensure laterality is documented to avoid unspecified coding.
Coding Notes
- Ensure documentation specifies the right hip and any chronicity or etiology if known.
M25.552 - Pain in left hip
Use when the patient presents with pain specifically in the left hip without a confirmed underlying condition like osteoarthritis.
Applicable To
- Left hip pain
Excludes
- Osteoarthritis of left hip (M16.12)
Clinical Validation Requirements
- Patient reports pain localized to the left hip
- Physical examination confirms tenderness in the left hip area
Coding Notes
Ensure documentation specifies the left hip and any chronicity or etiology if known.
M16.0 - Bilateral primary osteoarthritis of hip
Use when bilateral osteoarthritis is confirmed via imaging.
Applicable To
- Bilateral hip osteoarthritis
Excludes
- Pain in hip (M25.55)
Clinical Validation Requirements
- Radiographic evidence of osteoarthritis in both hips
- Patient reports bilateral hip pain
Coding Notes
Document imaging findings and confirm bilateral involvement.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other chronic pain
G89.29Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Painful Hip to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M25.551.
Impact
Clinical: May affect treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Always document the duration of pain., Include any functional limitations.
Impact
Reimbursement: May lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of patient records.
Mitigation Strategy
Always specify laterality and etiology when known.
Impact
Using unspecified codes without proper documentation.
Mitigation Strategy
Ensure all documentation specifies laterality and etiology.
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 Painful Hip, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Painful Hip
Use these documentation templates to ensure complete and accurate documentation for Painful Hip. These templates include all required elements for proper coding and billing.
Chronic Bilateral Hip Pain
Specialty: OrthopedicsRequired Elements
- Pain duration
- Laterality
- Functional impact
- Imaging findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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