Facebook tracking pixel
M25.559
ICD-10-CM
Painful Hip

Find information on painful hip diagnosis, including clinical documentation, medical coding, ICD-10 codes, differential diagnosis, treatment options, and prognosis. Explore resources for healthcare professionals regarding hip pain assessment, examination, and management. Learn about common causes of hip pain such as osteoarthritis, bursitis, labral tear, and tendinitis. This resource provides guidance on proper medical coding for painful hip conditions to ensure accurate reimbursement and compliant healthcare documentation.

Also known as

Hip Pain
Coxalgia

Diagnosis Snapshot

Key Facts
  • Definition : Hip pain encompassing any discomfort in or around the hip joint.
  • Clinical Signs : Limited range of motion, tenderness to touch, limping, stiffness, and referred pain to thigh or groin.
  • Common Settings : Osteoarthritis, bursitis, tendonitis, labral tears, and muscle strains.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC M25.559 Coding
M25.5

Pain in hip joint

Pain localized to the hip joint.

M79.6

Enthesopathies of lower limb

Pain related to tendon/ligament attachments around the hip.

S70-S79

Injuries to the hip and thigh

Includes fractures and other injuries causing hip pain.

M54.1-M54.9

Dorsalgia (excluding lumbago)

Pain in the back that may refer to the hip region.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the hip pain traumatic in origin?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Painful hip
Osteoarthritis of hip
Trochanteric bursitis

Documentation Best Practices

Documentation Checklist
  • Painful hip: Document laterality (left/right)
  • Specify onset date and duration of hip pain
  • Document pain characteristics: location, type, radiation
  • Include impact on ADLs and mobility/gait
  • Document associated symptoms (e.g., clicking, stiffness)

Coding and Audit Risks

Common Risks
  • Unspecified Hip Pain

    Coding M79.60, Painful hip, unspecified, without further documentation of laterality, etiology, or specific joint affected leads to claim denials and inaccurate data.

  • Osteoarthritis Coding

    Miscoding hip pain due to osteoarthritis (e.g., using M79.60 instead of M16) can impact DRG assignment and reimbursement, requiring CDI specialist review.

  • Trauma vs. Non-Trauma

    Failing to distinguish between traumatic (S79.90) and non-traumatic hip pain (M79.60) leads to coding errors impacting quality reporting and statistical analysis.

Mitigation Tips

Best Practices
  • Accurate ICD-10 coding (M25.5-, etc.) for hip pain diagnosis.
  • Specific laterality documentation (right/left hip) improves coding.
  • Detailed HPI improves CDI & risk adjustment for hip pain.
  • Query physicians for unclear hip pain documentation for accurate codes.
  • Regular coding audits ensure compliance and proper reimbursement.

Clinical Decision Support

Checklist
  • Verify laterality: Right or Left hip documented
  • Check pain onset, duration, and character
  • Physical exam: ROM, tenderness, gait assessment
  • Consider imaging: X-ray, MRI if indicated
  • Review prior hip injuries or surgeries

Reimbursement and Quality Metrics

Impact Summary
  • Painful Hip: Coding accuracy impacts reimbursement for hip pain diagnosis. Optimize ICD-10 (M25.5) and CPT codes for maximum payment.
  • Accurate Painful Hip coding improves hospital quality reporting metrics. Proper documentation supports severity and treatment effectiveness data.
  • Painful Hip diagnosis coding errors lead to claim denials and reduced hospital revenue. Accurate coding ensures appropriate reimbursement.
  • Timely Painful Hip coding and billing minimizes claim processing time. This improves hospital cash flow and reduces A/R days.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code laterality: right/left hip
  • Document pain characteristics
  • Specify onset and duration
  • Consider underlying cause
  • Rule out referred pain

Documentation Templates

Patient presents with complaints of hip pain, potentially indicative of several hip conditions including osteoarthritis, hip bursitis, labral tear, tendinitis, or referred pain.  Onset of pain is described as (acute, subacute, chronic), located in the (anterior, posterior, lateral) hip region, and characterized as (sharp, dull, aching, throbbing).  Patient reports pain aggravated by (weight-bearing activities, prolonged sitting, specific movements) and alleviated by (rest, ice, over-the-counter pain relievers such as ibuprofen or acetaminophen).  Range of motion in the affected hip is (limited, normal) with (positive, negative) impingement sign and (positive, negative) Trendelenburg sign.  Palpation reveals (tenderness, swelling, warmth) over the (greater trochanter, anterior hip joint, groin).  Patient's medical history includes (relevant past diagnoses, surgeries, medications).  Family history is notable for (osteoarthritis, rheumatoid arthritis, other relevant conditions).  Differential diagnosis includes osteoarthritis, trochanteric bursitis, hip impingement syndrome, labral tear, muscle strain, referred pain from the lumbar spine.  Assessment suggests (working diagnosis).  Plan includes (physical therapy referral, imaging studies such as X-ray or MRI, pain management strategies including NSAIDs or other analgesics, corticosteroid injection consideration, activity modification, follow-up appointment).  Patient education provided regarding hip pain causes, treatment options, and self-care strategies.  Coding considerations may include ICD-10 codes for hip pain (M25.5), osteoarthritis (M16), bursitis (M70), or other relevant diagnoses.  Medical billing will reflect evaluation and management services, diagnostic testing, and therapeutic interventions.