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v1.0.0
ICD-10 Guide
DiagnosesHip Degenerative

Hip Degenerative

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

PRIMARY SPECIALTYOrthopedics
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Hip Degenerative?
Essential facts and insights about Hip Degenerative Conditions

Key Clinical Considerations:

  • Joint pain and stiffness, especially after inactivity
  • X-rays showing joint space narrowing, osteophytes, and subchondral sclerosis
  • Limited range of motion and tenderness upon palpation of the hip joint

Clinical Information

Clinical Criteria & Documentation Requirements

  • Patient history including duration and severity of symptoms
  • Specific terminology such as 'osteoarthritis' or 'degenerative joint disease'
  • Examples include detailed descriptions of physical exam findings and imaging results

Coding Guidelines

Usage Guidelines & Examples

  • Follow usage guidelines for specific ICD codes related to hip degenerative conditions.
  • Common errors include misclassifying the type of osteoarthritis or failing to document severity.

Code Exclusions

Important Exclusions

  • Rheumatoid arthritis, post-traumatic arthritis, and other inflammatory joint diseases.
  • Alternative codes for hip pain not related to degenerative changes.

Related ICD-10 Codes

Primary Codes
M16.9
Osteoarthritis of hip, unspecified
M16.0
Primary osteoarthritis of hip
Ancillary Codes
M25.55
Differential Codes
M87.0
M16.0

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Orthopedics

Specialty Applications

  • Older adults, athletes with repetitive hip stress, and individuals with a history of hip injuries.
  • Orthopedic clinics, rehabilitation centers, and primary care settings.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

Documentation requirements?

Include detailed patient history, physical exam findings, and imaging results.

Billing considerations?

Ensure accurate coding to reflect the severity and type of degenerative changes.