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ICD-10 Coding for Hip Degenerative Conditions(M16.0, M16.1, M16.5)

Complete ICD-10-CM coding and documentation guide for Hip Degenerative Conditions. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Hip OsteoarthritisDegenerative Joint Disease of the Hip

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Related ICD-10 Code Ranges

Complete code families applicable to Hip Degenerative Conditions

M16.0-M16.9Primary Range

Osteoarthritis of hip

This range covers all primary and secondary osteoarthritis conditions affecting the hip, including bilateral and unilateral presentations.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
M16.0Bilateral primary osteoarthritis of hipUse when both hips are affected by primary osteoarthritis.
  • Radiographic evidence of joint space narrowing
  • Clinical documentation of bilateral hip pain
M16.1Unilateral primary osteoarthritis of hipUse when only one hip is affected by primary osteoarthritis.
  • Radiographic evidence of joint space narrowing
  • Clinical documentation of unilateral hip pain
M16.5Unilateral post-traumatic osteoarthritis of hipUse when osteoarthritis is secondary to trauma.
  • History of trauma to the hip
  • Radiographic evidence of degenerative changes

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 osteoarthritis

Essential facts and insights about Hip Degenerative Conditions

The ICD-10 code for bilateral primary osteoarthritis of the hip is M16.0.

Primary ICD-10-CM Codes for hip degenerative

M16.0
Bilateral primary osteoarthritis of hip
Billable Code

Decision Criteria

clinical Criteria

  • Bilateral hip pain with radiographic evidence

Applicable To

  • Degenerative changes of both hips

Excludes

Clinical Validation Requirements

  • Radiographic evidence of joint space narrowing
  • Clinical documentation of bilateral hip pain

Code-Specific Risks

  • Risk of using unspecified codes when laterality is clear

Coding Notes

  • Ensure documentation specifies bilateral involvement.
View Full Code Details

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Pain in hip

M25.55
Use to document pain associated with osteoarthritis.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Idiopathic aseptic necrosis of bone

M87.0
Use when imaging shows necrosis rather than degenerative changes.

Bilateral primary osteoarthritis of hip

M16.0
Use when no trauma history is present.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Hip Degenerative Conditions to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code M16.0.

Impact

Clinical: Impacts treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for reduced reimbursement.

Mitigation Strategy

Always include laterality in documentation., Use templates that prompt for laterality.

Impact

Reimbursement: May lead to reduced reimbursement rates., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Decreases the accuracy of clinical data.

Mitigation Strategy

Always specify laterality when it is documented in the clinical notes.

Impact

Using unspecified codes when specific codes are available.

Mitigation Strategy

Ensure documentation supports the most specific code available.

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 Degenerative Conditions, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Hip Degenerative Conditions

Use these documentation templates to ensure complete and accurate documentation for Hip Degenerative Conditions. These templates include all required elements for proper coding and billing.

Orthopedic Evaluation for Hip OA

Specialty: Orthopedics

Required Elements

  • Diagnosis
  • Clinical Findings
  • Imaging Results
  • Treatment Plan

Example Documentation

Diagnosis: Primary OA right hip (M16.11) Clinical Findings: Pain in right groin, worsens with weight-bearing Imaging: X-ray shows joint space <2mm, osteophytes Plan: Total hip arthroplasty scheduled

Examples: Poor vs. Good Documentation

Poor Documentation Example
Patient has hip pain.
Good Documentation Example
Patient has primary osteoarthritis of the right hip, confirmed by X-ray showing joint space narrowing.
Explanation
The good example specifies the type of arthritis and provides radiographic confirmation.

Need help with ICD-10 coding for Hip Degenerative Conditions? Ask your questions below.

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