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ICD-10 Guide
ICD-10 CodesM21.259

M21.259

Billable

Flexion deformity, unspecified hip

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

Code Description

ICD-10 M21.259 is a billable code used to indicate a diagnosis of flexion deformity, unspecified hip.

Key Diagnostic Point:

Flexion deformity of the hip refers to a condition where the hip joint is unable to extend fully, resulting in a fixed position that can lead to functional impairment. This deformity can be acquired due to various factors, including trauma, neurological conditions, or prolonged immobilization. Patients may present with limited range of motion, pain, and difficulty in ambulation. The condition can significantly impact the quality of life, as it may hinder daily activities and mobility. Treatment options often involve physical therapy, bracing, or surgical interventions such as osteotomy or arthroplasty, depending on the severity and underlying cause of the deformity. Accurate diagnosis and documentation are crucial for effective management and coding, as the unspecified nature of this code requires careful consideration of the patient's clinical history and presentation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of the deformity
  • Need for comprehensive documentation to support the diagnosis
  • Potential overlap with other hip deformities and conditions
  • Variations in treatment approaches and their documentation

Audit Risk Factors

  • Insufficient documentation of the deformity's cause
  • Lack of detailed clinical notes regarding treatment plans
  • Inconsistent use of the code across different providers
  • Failure to document associated conditions or comorbidities

Specialty Focus

Medical Specialties

Orthopedics

Documentation Requirements

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

Common Clinical Scenarios

Patients with post-traumatic hip flexion deformities or those with congenital hip dysplasia.

Billing Considerations

Orthopedic surgeons should document the specific nature of the deformity and any associated conditions to ensure accurate coding.

Physical Medicine and Rehabilitation

Documentation Requirements

Comprehensive assessments including functional limitations and rehabilitation goals.

Common Clinical Scenarios

Patients undergoing rehabilitation post-surgery for hip deformities or those with neurological conditions affecting hip function.

Billing Considerations

Documentation should focus on the impact of the deformity on functional abilities and the rehabilitation process.

Coding Guidelines

Inclusion Criteria

Use M21.259 When
  • According to ICD
  • 10 guidelines, M21
  • 259 should be used when the specific cause of the flexion deformity is not documented
  • Coders should ensure that the diagnosis is supported by clinical documentation and that any related conditions are also coded appropriately

Exclusion Criteria

Do NOT use M21.259 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

27130CPT Code

Total hip arthroplasty

Clinical Scenario

Used in cases where the flexion deformity is severe and surgical intervention is necessary.

Documentation Requirements

Operative reports detailing the procedure and indications for surgery.

Specialty Considerations

Orthopedic surgeons should ensure that the deformity is well-documented to justify 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 flexion deformity, enabling better tracking of patient outcomes and resource allocation. However, the unspecified nature of M21.259 may lead to challenges in reimbursement if not properly documented.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like flexion deformity, enabling better tracking of patient outcomes and resource allocation. However, the unspecified nature of M21.259 may lead to challenges in reimbursement if not properly documented.

Reimbursement & Billing Impact

reimbursement if not properly documented.

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 is the significance of using M21.259?

M21.259 is significant as it captures the diagnosis of flexion deformity of the hip when the specific cause or laterality is not documented. Accurate use of this code is essential for proper reimbursement and tracking of patient outcomes.