ICD-10 Coding for Right Hip Pain(M25.551, M16.11, M70.61, T84.030A)
Complete ICD-10-CM coding and documentation guide for Right Hip Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Right Hip Pain
M25.5Primary Range
Pain in joint
This range includes codes for pain in specific joints, including the hip.
Mechanical complications of internal joint prosthesis
Used for complications related to hip prosthesis.
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 pain is the primary symptom without a definitive diagnosis. |
|
| M16.11 | Unilateral primary osteoarthritis, right hip | Use when osteoarthritis is confirmed as the cause of hip pain. |
|
| M70.61 | Trochanteric bursitis, right hip | Use when trochanteric bursitis is confirmed as the cause of hip pain. |
|
| T84.030A | Mechanical loosening of internal right hip prosthesis | Use when there is mechanical loosening of a right hip prosthesis. |
|
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 right hip pain
Essential facts and insights about Right Hip Pain
Primary ICD-10-CM Codes for right hip pain
Decision Criteria
clinical Criteria
- Pain localized to the right hip with no other definitive diagnosis.
documentation Criteria
- Detailed description of pain characteristics and functional impact.
Clinical Validation Requirements
- Pain localization to right hip
- Objective findings such as positive FABER test
Code-Specific Risks
- Incorrectly using this code for post-surgical pain without specifying complications.
Coding Notes
- Ensure documentation specifies laterality and any aggravating factors.
M16.11 - Unilateral primary osteoarthritis, right hip
Use when osteoarthritis is confirmed as the cause of hip pain.
Applicable To
- Osteoarthritis of right hip
Excludes
- Pain in right hip (M25.551)
Clinical Validation Requirements
- Radiographic evidence of osteoarthritis
Coding Notes
Ensure radiographic evidence is documented.
M70.61 - Trochanteric bursitis, right hip
Use when trochanteric bursitis is confirmed as the cause of hip pain.
Applicable To
- Bursitis of right hip
Excludes
- Pain in right hip (M25.551)
Clinical Validation Requirements
- Clinical tests such as pain with resisted abduction
Coding Notes
Document specific clinical tests confirming bursitis.
T84.030A - Mechanical loosening of internal right hip prosthesis
Use when there is mechanical loosening of a right hip prosthesis.
Applicable To
- Loosening of right hip prosthesis
Excludes
- Pain in right hip (M25.551)
Clinical Validation Requirements
- Imaging evidence of prosthesis loosening
Coding Notes
Ensure imaging confirms prosthesis issue.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Other abnormalities of gait and mobility
R26.89Differential 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 Right Hip Pain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M25.551.
Impact
Clinical: Leads to inadequate treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials due to insufficient detail.
Mitigation Strategy
Use specific descriptors for pain, Include objective findings
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use T84.030A for mechanical complications and M25.551 for associated pain.
Impact
Risk of incorrect coding for post-surgical hip pain.
Mitigation Strategy
Verify imaging and clinical findings before coding.
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 Right Hip Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Right Hip Pain
Use these documentation templates to ensure complete and accurate documentation for Right Hip Pain. These templates include all required elements for proper coding and billing.
Chronic Right Hip Pain
Specialty: OrthopedicsRequired Elements
- Pain characteristics
- Functional impact
- Objective findings
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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