ICD-10 Coding for Bilateral Hip Pain(M25.551, M25.552, M16.0)
Complete ICD-10-CM coding and documentation guide for Bilateral Hip Pain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Bilateral Hip Pain
M25.55Primary Range
Pain in joint
This range includes codes for joint pain, specifically for the hip, and is used when the pain is not attributed to a specific condition like osteoarthritis.
Osteoarthritis of hip
This range is used when hip pain is confirmed to be due to osteoarthritis, with specific codes for bilateral involvement.
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. |
|
| M25.552 | Pain in left hip | Use when the patient presents with pain specifically in the left hip without a confirmed underlying condition. |
|
| M16.0 | Bilateral primary osteoarthritis of hip | Use when bilateral hip pain is confirmed to be due to osteoarthritis. |
|
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 bilateral hip pain
Essential facts and insights about Bilateral Hip Pain
Primary ICD-10-CM Codes for bilateral hip pain
Decision Criteria
clinical Criteria
- Pain localized to the right hip with no confirmed diagnosis
Applicable To
- Right hip joint pain
Excludes
- Osteoarthritis of right hip (M16.11)
Clinical Validation Requirements
- Patient reports pain localized to the right hip
- Physical exam confirms tenderness over the right hip
Code-Specific Risks
- Risk of using this code without specifying laterality
Coding Notes
- Ensure documentation specifies the right hip to avoid unspecified coding.
M25.552 - Pain in left hip
Use when the patient presents with pain specifically in the left hip without a confirmed underlying condition.
Applicable To
- Left hip joint pain
Excludes
- Osteoarthritis of left hip (M16.12)
Clinical Validation Requirements
- Patient reports pain localized to the left hip
- Physical exam confirms tenderness over the left hip
Coding Notes
Ensure documentation specifies the left hip to avoid unspecified coding.
M16.0 - Bilateral primary osteoarthritis of hip
Use when bilateral hip pain is confirmed to be due to osteoarthritis.
Applicable To
- Bilateral hip osteoarthritis
Excludes
- Pain in joint (M25.55)
Clinical Validation Requirements
- Radiographic evidence of osteoarthritis in both hips
Coding Notes
Ensure imaging reports are included in documentation to support this code.
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 Bilateral 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: May lead to incorrect diagnosis and treatment., Regulatory: Non-compliance with coding guidelines., Financial: Potential claim denials due to insufficient documentation.
Mitigation Strategy
Always include imaging results in the patient's record., Ensure radiologist reports are attached to the clinical documentation.
Impact
Reimbursement: May lead to claim denials due to lack of specificity., Compliance: Non-compliance with coding guidelines requiring laterality., Data Quality: Reduces data accuracy for clinical and research purposes.
Mitigation Strategy
Use M25.551 and M25.552 to specify laterality.
Impact
High risk of audit for using unspecified codes like M25.559.
Mitigation Strategy
Always specify laterality and confirm diagnosis with imaging.
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 Bilateral Hip Pain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Bilateral Hip Pain
Use these documentation templates to ensure complete and accurate documentation for Bilateral Hip Pain. These templates include all required elements for proper coding and billing.
Undiagnosed bilateral hip pain
Specialty: OrthopedicsRequired Elements
- Diagnosis
- History of present illness
- Physical examination findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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