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v1.0.0
ICD-10 Guide
ICD-10 CodesM25.55

M25.55

Billable

Pain in hip

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/17/2025

Code Description

ICD-10 M25.55 is a billable code used to indicate a diagnosis of pain in hip.

Key Diagnostic Point:

Pain in the hip can arise from various internal derangements, including meniscal tears, ligament injuries, and degenerative conditions such as osteoarthritis. The hip joint is a ball-and-socket joint that allows for a wide range of motion, but this complexity also makes it susceptible to injuries and degenerative changes. Internal derangements may involve the labrum, cartilage, or ligaments, leading to pain, swelling, and reduced mobility. Meniscal tears, although more commonly associated with the knee, can also refer to hip pain when there is associated injury to the acetabular labrum. Ligament injuries, such as sprains or tears of the hip ligaments, can result from acute trauma or chronic overuse. Arthroscopic procedures are often employed to diagnose and treat these conditions, allowing for minimally invasive intervention. Accurate coding for hip pain requires a thorough understanding of the underlying causes, as well as the specific procedures performed to address these issues.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes (e.g., internal derangements, arthritis)
  • Differentiation between acute and chronic conditions
  • Need for detailed documentation of clinical findings
  • Potential for co-existing conditions affecting the hip

Audit Risk Factors

  • Inadequate documentation of the specific cause of pain
  • Failure to document the treatment plan or procedures performed
  • Misclassification of acute vs. chronic pain
  • Lack of clarity on co-existing conditions

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

Detailed notes on physical examination findings, imaging results, and treatment plans.

Common Clinical Scenarios

Patients presenting with hip pain due to osteoarthritis, ligament injuries, or post-surgical pain.

Billing Considerations

Ensure documentation reflects the specific nature of the pain and any associated procedures.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessment of functional limitations and treatment goals.

Common Clinical Scenarios

Rehabilitation following hip surgery or management of chronic hip pain.

Billing Considerations

Focus on functional outcomes and the impact of pain on daily activities.

Coding Guidelines

Inclusion Criteria

Use M25.55 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the pain's duration, severity, and any associated conditions
  • Include details of any surgical procedures performed

Exclusion Criteria

Do NOT use M25.55 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

29862CPT Code

Arthroscopy, hip, diagnostic

Clinical Scenario

Used when performing a diagnostic arthroscopy for hip pain.

Documentation Requirements

Document indications for the procedure and findings.

Specialty Considerations

Orthopedic specialists should ensure clarity in the surgical report.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding hip pain, enabling better tracking of treatment outcomes and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding hip pain, enabling better tracking of treatment outcomes and resource allocation.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding hip pain, enabling better tracking of treatment outcomes and resource allocation.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What documentation is needed to support the use of M25.55?

Documentation should include a detailed history of the patient's hip pain, physical examination findings, imaging results, and any treatment plans or procedures performed.