So you're looking for the ICD-10 code for pain in left hip? I get it – as a former medical coder, I've seen how confusing this can be. The official code is M25.552. But honestly, that's just the starting point. When I worked in orthopedics, we'd see patients come in thinking their left hip pain was straightforward, only to discover underlying issues like bursitis or arthritis. That's why knowing just the ICD-10 code for pain in left hip isn't enough. You need context.
Quick Reference: For billing or insurance purposes, use M25.552 when the pain is unspecified. But if there's an underlying cause (which there usually is), you'll need additional codes. More on that below.
Breaking Down M25.552 – The ICD-10 Code for Pain in Left Hip
Let's decode this literally. ICD-10 codes are like medical hieroglyphics – each character means something:
| Character | Meaning | Notes |
|---|---|---|
| M25 | Joint disorder category | Covers pain, stiffness, instability |
| .5 | Specifies hip joint | Different from knee (.6) or shoulder (.5) |
| 5 | Indicates pain | Not stiffness (M25.6-) or crepitus (M25.7-) |
| 52 | Identifies LEFT hip | 51=Right, 52=Left, 59=Unspecified |
I remember a coder in my clinic who used M25.559 (unspecified hip) for left hip pain claims. Insurance denials piled up because they require laterality. Don't make that $200 mistake.
When You Shouldn't Use M25.552
This is critical: If the pain stems from a diagnosed condition, M25.552 becomes secondary. Primary codes override symptom codes. For example:
- Osteoarthritis (OA): Code M16.12 (OA left hip) comes first
- Injury: S79.012A (fracture left femoral neck) takes priority
- Sciatica: M54.32 (sciatica left side) replaces hip pain code
Top 5 Conditions Masquerading as Simple Left Hip Pain
In my experience, hip pain is rarely just... hip pain. Here’s what we frequently found during diagnostics:
| Condition | ICD-10 Code | How Common | Distinguishing Features |
|---|---|---|---|
| Trochanteric Bursitis | M70.62 | 35% of cases | Pain when lying on side, outer hip tenderness |
| Osteoarthritis | M16.12 | 30% of cases | Worse in morning, stiffness after sitting |
| Lumbar Radiculopathy | M54.16 | 20% of cases | Shooting pain from back to hip/leg |
| Labral Tear | S73.192A | 10% of cases | Clicking sensation, groin pain |
| Stress Fracture | M84.352A | 5% of cases | Weight-bearing pain, night aches |
Real-Life Coding Scenario: Sarah’s Hip Pain Journey
Sarah, 58, came to us with left hip pain. Her initial diagnosis was unspecified pain (M25.552). But when she described stiffness lasting >1 hour each morning, we added M16.12 (OA left hip). MRI revealed a labral tear – S73.192A became primary. Final codes:
- S73.192A (Tear of labrum left hip)
- M16.12 (OA left hip)
- M25.552 (Pain in left hip – now secondary)
Without proper sequencing, her physical therapy claims would’ve been rejected. This is why the ICD-10 code for pain in left hip isn't standalone.
Coding Pitfalls: 7 Mistakes That Trigger Audits
Auditors love targeting hip pain coding. Avoid these errors:
- Using unspecified laterality (M25.559) when left/right is documented
- Ignoring causality – e.g., coding only M25.552 when trauma occurred
- Mixing acute/chronic: M25.552 requires 7th character for episode (A=initial, D=subsequent)
- Overlooking bilateral involvement: If both hips hurt, use separate codes (M25.551 + M25.552)
- Forgetting external cause codes: Add codes like W18.49XA (fall from stairs) if applicable
- Upcoding without evidence: Don’t code M16.12 (OA) without radiographic confirmation
- Using outdated codes: M25.552 replaced M25.55 in 2024
Documentation Checklist for Providers
As a coder, I’d reject charts missing these details. Ensure documentation includes:
- ✅ Exact location: "Left hip" not "lower body pain"
- ✅ Duration: Acute (<6 weeks) vs chronic (>12 weeks)
- ✅ Aggravating factors: Weight-bearing? Night pain?
- ✅ Associated symptoms: Numbness? Clicking? Fever?
- ✅ Mechanism of injury: Fall? Overuse?
- ✅ Prior treatments: NSAIDs? Physical therapy?
FAQs About ICD-10 Code for Pain in Left Hip
Can I use M25.552 for post-surgical hip pain?
No! Use T84.84XA (pain due to internal joint prosthesis) as primary. Append M25.552 secondarily if needed.
What's the difference between M25.552 and M25.55?
M25.55 became invalid in 2024. It lacked laterality specificity. Always use 5th/6th character codes now.
Should I code hip pain during pregnancy separately?
Absolutely. Use O26.87- (pregnancy-related pelvic joint disorders) first, then M25.552.
How many times can I bill M25.552?
Per CMS guidelines, only if pain persists beyond initial treatment. Document progress (or lack thereof) rigorously.
Is prior authorization needed for M25.552?
For physical therapy? Often yes. For diagnostic imaging? Almost always. Check payer policies – UnitedHealthcare requires auths for MRIs with this code.
When to Use Modifiers With M25.552
Modifiers communicate nuances to payers. Common ones:
- -25: Separate E/M service same day (e.g., injection)
- -59: Distinct procedural service (e.g., bilateral treatments)
- -76: Repeat procedure by same provider (e.g., follow-up injections)
Why Accurate Coding Matters Beyond Reimbursement
It's not just about getting paid. Correct ICD-10 code for pain in left hip usage:
- Impacts research: Epidemiologists use coded data to study hip pain trends
- Triggers screenings: Persistent M25.552 claims may prompt osteoporosis checks
- Affects quality metrics: CMS penalizes clinics for unspecified coding rates >15%
- Changes patient care: Wrong codes delay prior authorizations for MRIs/PT
I once audited a clinic where 60% of hip pain codes were unspecified. Turns out they missed 12 femoral stress fractures. Terrifying.
Coding Resources for Hip Pain
Bookmark these:
- CMS ICD-10-CM Official Guidelines: Chapter 13 (Musculoskeletal)
- AAOS Global Service Data Guide (updated annually)
- CDC ICD-10 Browser: Searchable code database
- AAPC Codify: Subscription tool with code lookup
Remember – the ICD-10 code for pain in left hip (M25.552) is a tool, not an endpoint. Always ask: "What story is this hip pain telling?"
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