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v1.0.0
ICD-10 Guide
ICD-10 CodesM25.552

M25.552

Billable

Pain in left hip

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

Code Description

ICD-10 M25.552 is a billable code used to indicate a diagnosis of pain in left hip.

Key Diagnostic Point:

Pain in the left hip can arise from various internal derangements, including meniscal tears, ligament injuries, and degenerative conditions such as osteoarthritis. The hip joint is a complex structure that allows for a wide range of motion, making it susceptible to injuries and degenerative changes. Internal derangements may involve the labrum, ligaments, or cartilage, leading to pain, swelling, and limited mobility. Meniscal tears, while more commonly associated with the knee, can also occur in the hip joint, particularly in athletes or individuals engaged in high-impact activities. 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 pain in the left hip requires a thorough understanding of the underlying causes and associated conditions, as well as the specific documentation provided by healthcare providers.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential underlying causes (e.g., internal derangements, arthritis)
  • Need for precise documentation of pain characteristics and duration
  • Differentiation from similar codes related to hip pain
  • Potential for co-existing conditions that may complicate coding

Audit Risk Factors

  • Inadequate documentation of the specific nature of the pain
  • Failure to document co-existing conditions
  • Lack of clarity on the cause of pain (e.g., trauma vs. degenerative)
  • Improper linkage of diagnosis to procedures performed

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 sports injuries, degenerative joint disease, or post-surgical complications.

Billing Considerations

Ensure that all relevant imaging studies and their interpretations are documented to support the diagnosis.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments including functional limitations and treatment goals.

Common Clinical Scenarios

Rehabilitation following hip surgery or injury, chronic pain management.

Billing Considerations

Document the patient's response to therapy and any changes in pain levels or functional status.

Coding Guidelines

Inclusion Criteria

Use M25.552 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the code is used only when the documentation supports a diagnosis of pain specifically localized to the left hip

Exclusion Criteria

Do NOT use M25.552 When
  • Exclude codes for pain due to trauma or other specific conditions unless they are documented

Related ICD-10 Codes

Related CPT Codes

29862CPT Code

Arthroscopy, hip, diagnostic

Clinical Scenario

Used when performing a diagnostic arthroscopy for left hip pain.

Documentation Requirements

Document indications for the procedure and findings during the arthroscopy.

Specialty Considerations

Orthopedic specialists should ensure that all findings are clearly documented to support the procedure.

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 left hip pain, improving the granularity of data for treatment and outcomes. This specificity aids in better tracking of treatment efficacy and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like left hip pain, improving the granularity of data for treatment and outcomes. This specificity aids in better tracking of treatment efficacy and resource allocation.

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 needed to support the use of M25.552?

Documentation should include a detailed history of the patient's symptoms, physical examination findings, imaging results, and any treatments provided. It is crucial to specify the nature of the pain and any underlying conditions.