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ICD-10 Guide
ICD-10 CodesM25.551

M25.551

Billable

Pain in right hip

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

Code Description

ICD-10 M25.551 is a billable code used to indicate a diagnosis of pain in right hip.

Key Diagnostic Point:

Pain in the right hip can arise from various internal derangements, including meniscal tears, ligament injuries, and degenerative conditions such as osteoarthritis. The hip joint, being a ball-and-socket joint, is susceptible to injuries that can lead to pain and functional impairment. Meniscal tears, while more commonly associated with the knee, can also refer pain to the hip region due to shared nerve pathways. Ligament injuries, such as sprains or tears of the hip ligaments, can result from acute trauma or chronic overuse, leading to inflammation and pain. Arthroscopic procedures may be indicated for diagnosis and treatment of these conditions, allowing for minimally invasive intervention to repair damaged structures or remove loose bodies. Accurate coding for pain in the right hip requires a thorough understanding of the underlying causes, as well as the specific documentation of the patient's clinical presentation and any imaging or surgical findings.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between various causes of hip pain (e.g., internal derangements vs. arthritis)
  • Need for precise documentation of the patient's history and physical examination findings
  • Potential for overlapping symptoms with other conditions (e.g., referred pain from lumbar spine issues)
  • Variability in treatment approaches and procedures (e.g., conservative vs. surgical management)

Audit Risk Factors

  • Inadequate documentation of the specific cause of hip pain
  • Failure to link the diagnosis to the treatment provided
  • Misuse of codes for related conditions or procedures
  • Inconsistent coding of bilateral vs. unilateral 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 acute hip pain following trauma, chronic pain due to degenerative changes, or post-operative follow-ups.

Billing Considerations

Ensure documentation reflects the specific nature of the injury or condition, including any surgical interventions performed.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessment of functional limitations and rehabilitation goals.

Common Clinical Scenarios

Patients requiring rehabilitation post-surgery or those with chronic hip pain affecting mobility.

Billing Considerations

Document the impact of hip pain on daily activities and the patient's response to therapy.

Coding Guidelines

Inclusion Criteria

Use M25.551 When
  • According to ICD
  • 10 guidelines, M25
  • 551 should be used when the primary complaint is pain localized to the right hip
  • Coders must ensure that the documentation supports the diagnosis and that any associated conditions are also coded appropriately

Exclusion Criteria

Do NOT use M25.551 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

29862CPT Code

Arthroscopy, hip, diagnostic

Clinical Scenario

Used for patients with suspected internal derangements of the hip.

Documentation Requirements

Document indications for the procedure and findings during the arthroscopy.

Specialty Considerations

Orthopedic specialists should ensure that the procedure is justified based on clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like hip pain, improving the granularity of data for treatment and outcomes analysis. M25.551 provides a clear designation for right hip pain, facilitating better tracking and management of hip-related conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like hip pain, improving the granularity of data for treatment and outcomes analysis. M25.551 provides a clear designation for right hip pain, facilitating better tracking and management of hip-related conditions.

Reimbursement & Billing Impact

reimbursement.

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 required to support the use of M25.551?

Documentation should include a detailed history of the patient's symptoms, physical examination findings, imaging results, and any treatments provided. It is essential to clearly indicate the cause of the pain and any functional limitations experienced by the patient.