ICD-10 Codes for Hip Pain: The Rundown

Hip pain is a common complaint in rehabilitation therapy. Understanding the causes of hip pain and the corresponding ICD-10-CM diagnosis code is needed for accurate diagnosis, effective treatment, and proper billing. This post will explore the common sources of hip pain and their corresponding codes.

ICD-10 Coding Basics 

International Classification of Diseases, 10th Revision (ICD-10) is a standard set of diagnosis codes that ensures correct documentation, appropriate compensation, and efficient communication with other healthcare professionals. The ICD-10-CM Diagnosis system categorizes various medical conditions, such as pain in specific areas of the body, and assigns corresponding codes for accurate coding and billing purposes.

Typically, ICD-10 codes are between three and seven characters long and include several elements.

• Category: represented by the first three characters. For example, diseases of the musculoskeletal system and connective tissue are M00 – M99; osteoarthritis specifically is M15 – M19.
• Etiology: represented by the fourth character. For hip osteoarthritis, the code is M16.9 when unspecified, but traumatic arthritis is M16.4.
• Anatomic Site: represented by the fifth character.
• Specific Conditions: represented by the sixth and seventh characters. This is used to identify laterality or whether the encounter is the initial one, a subsequent encounter, or a sequela from another condition.

Being as specific as possible is essential when coding for hip pain. Using the most comprehensive code guarantees that the patient’s condition is accurately represented, assisting in treatment planning.

Benefits of ICD-10 Codes

ICD-10 codes are the international standard for a reason. Here are some of the major benefits of ICD-10 codes for practitioners.

• Quality measurement: ICD-10 codes provide more specific information, leading to better data for tracking health conditions, patient outcomes, public health policy, and research.
• Public health: The codes are used globally to track diseases, health statistics, and causes of death.
• Reimbursement: Insurance companies, policymakers, and healthcare providers use the data to change US reimbursement systems.

Common Causes of Hip Pain

Hip pain in adults can be caused by various conditions affecting the surrounding bones and tissues. Mild discomfort can result from overuse of a muscle or tendon when participating in sports or other types of activities, whether moderate or more strenuous. In middle-aged and older individuals, degenerative changes to both the bony structures and cartilage can increase pain and discomfort. Chronic pain is a common issue in middle-aged and older individuals, significantly impacting their daily life and overall quality of life.

The location of the pain can offer clues to diagnosis. In older adults, pain along the front of the hip or the groin can indicate the presence of arthritis, while pain along the outer part of the hip may be due to bursitis. Pain along the back of the hip or buttock area is often related to the spine rather than the hip joint.

Common sources of hip pain:

1. Osteoarthritis
2. Sacroiliac Joint Dysfunction
3. Bursitis
4. Labral Tear
5. Hip Impingement
6. Hip Flexor Strain
7. Iliotibial Band Syndrome

Let’s take a look at each of these conditions along with their relevant ICD-10 codes.

Hip Osteoarthritis

Osteoarthritis (OA) is one of the most common causes of hip pain, especially in older adults. It is a form of degenerative joint disease characterized by the breakdown of cartilage in the hip joint, leading to pain, stiffness, and reduced mobility.

Hip osteoarthritis can develop faster in some individuals due to an irregular ball and socket joint shape, leading to hip impingement. Hip dysplasia is another condition that can cause pain, resulting from a shallow hip socket that cannot support the ball of the femur. As a result, cartilage wears away prematurely.

The M16 series of ICD-10 codes covers osteoarthritis of the hip:

• M16.0: Bilateral primary osteoarthritis of hip
• M16.1: Unilateral primary osteoarthritis of hip
• M16.2: Bilateral osteoarthritis resulting from hip dysplasia
• M16.3: Unilateral osteoarthritis resulting from hip dysplasia
• M16.4: Bilateral post-traumatic osteoarthritis of hip
• M16.5: Unilateral post-traumatic osteoarthritis of hip
• M16.6: Other bilateral secondary osteoarthritis of hip
• M16.7: Other unilateral secondary osteoarthritis of hip
• M16.9: Osteoarthritis of hip, unspecified

When treating patients with hip OA, rehab therapists typically focus on pain management, improving range of motion, and strengthening the surrounding muscles. The specific ICD-10 code used should reflect the type of OA (primary, secondary, or post-traumatic) and whether it is unilateral or bilateral.

Sacroiliac Joint Dysfunction

The sacroiliac (SI) joint connects the sacrum to the iliac bones of the pelvis. SI joints can develop degenerative arthritis from wear and tear or injury. Treatment will depend on how loose or stiff the joint is. SI joints that are stiff may require mobilization, while joints that are too loose may require stabilization. 

Several ICD-10 code series are potentially relevant for SI joint pain.

• M43.2: Fusion of spine – this refers to ankylosis of the spinal joint
• M43.8: Other specified deforming dorsopathies – this can be bending forward (kyphosis), bending backward (lordosis), or sideway (scoliosis)
• M53.3: Sacrococcygeal disorders, not elsewhere classified
• M99.0: Segmental and somatic dysfunction
• S33.6: Sprain and strain of sacroiliac joint

The specific code used will depend on the underlying cause of the SI joint pain. For instance, if the pain is due to a sprain, S33.6 would be appropriate. If it’s related to joint dysfunction, M99.0 might be more appropriate.

Treatment for SI joint pain often involves manual therapy, exercises to improve stability, and modalities for pain relief. The chosen ICD-10 code should align with the specific diagnosis and treatment approach.

Bursitis

Bursae are fluid-filled sacs that reduce friction between tissues by acting as cushions. These bursae are located near tendons in larger joints such as the shoulder, elbows, hips, and knees. Inflammation of these sacs is known as bursitis.

Bursitis is usually temporary and seldom causes deformity. However, it can limit mobility. Hip bursitis is one of the more common types and can result from overuse, injuries, spinal abnormalities, and even surgery.

ICD-10 codes that relate to bursitis include:

• M70  Soft tissue disorders related to use, overuse and pressure
• M70.7  Other bursitis of hip

Labral Tear

Labral tears are injuries to the cartilage ring on the socket part of the hip joint, which is a ball-and-socket joint. During movement, the labrum keeps the femoral head and the pelvis in alignment, ensuring frictionless movement by keeping joint fluid inside the joint. Injuries to the labrum can be produced by wear and tear or trauma.

There are a few ICD-10 codes for labral tears, including:

• S73.192A Other sprain of left hip initial encounter – Left hip labrum tear
• S73.191A Other sprain of right hip initial encounter – Right hip labrum tear
• S73.199A Other sprain unspecified hip initial

Hip Impingement

Hip impingement, or femoroacetabular impingement, occurs when the femoral head presses against the acetabulum. There are two basic types, each classified based on the deformity of the femoral head or the acetabulum.

• M24  Other specific joint derangements
• M24.8  Other specific joint derangements, not elsewhere classified
• M24.85  Other specific joint derangements of hip, not elsewhere classified

Hip Flexor Strain

The hip flexors connect the top of the femur to the lower back, hips, and groin. They contribute to mobility, along with the iliacus, psoas major muscles, and the rectus femoris (part of the quadriceps).

Injuries to these muscles and tendons can result from overuse or overstretching, leading to pain and reduced mobility.

The S76 series covers injuries to muscles and tendons at the hip and thigh level, like:

• S76.011: Strain of muscle, fascia, and tendon of right hip
• S76.012: Strain of muscle, fascia, and tendon of left hip
• S76.019: Strain of muscle, fascia, and tendon of unspecified hip

Iliotibial Band Syndrome

The iliotibial band runs from the top of the pelvic bone along the outside of the leg. When stress is exerted, the tension can cause the band to rub against the bones, creating a painful tightness and knee pain. The initial pain of iliotibial band syndrome is often described as achy or burning. Over time, as the syndrome progresses, leg exercises become more difficult, and the pain increases.

The M76.3 series specifically addresses iliotibial band syndrome (ITBS) with these codes:

• M76.31: Iliotibial band syndrome, right leg
• M76.32: Iliotibial band syndrome, left leg
• M76.30: Iliotibial band syndrome, unspecified leg

Unspecified Hip Pain

Sometimes, the exact cause of hip pain may not be immediately apparent. While it’s always preferable to use a more specific diagnosis when possible, there are ICD-10 codes available for unspecified hip pain, including right hip pain.

The M25.55 series covers pain in the hip with:

• M25.551: Pain in right hip
• M25.552: Pain in left hip
• M25.559: Pain in unspecified hip

While these codes can be helpful in initial assessments, rehab therapists should strive to determine a more specific diagnosis as treatment progresses. This allows for more targeted interventions and more accurate coding.

Documentation Best Practices

Proper documentation is crucial for accurate coding and efficient patient treatment. When recording cases of hip pain, rehab therapists should identify a particular diagnosis. 

1. Clearly state the specific diagnosis.
2. Document the affected side (right, left, or bilateral).
3. Note any relevant history (e.g., trauma, overuse).
4. Describe the patient’s symptoms in detail.
5. Outline the treatment plan and its relation to the diagnosis.

By linking the diagnosis to the treatment plan in the documentation, therapists can support the specific ICD-10 codes and the medical necessity of their interventions.

To maintain coding accuracy and compliance, rehab therapists should:

1. Regularly review and update their knowledge of ICD-10 codes.
2. Use the most specific code available for each patient’s condition.
3. Verify that the documented diagnosis supports the chosen code.
4. Provide additional documentation if requested by payers.

Code Crackdown: Why Rehab Therapists Need ICD-10 Skills

Knowledge of anatomy is essential for therapists to provide proper care. However, becoming acquainted with the various ICD-10 codes used to describe conditions and Current Procedural Terminology (CPT) codes for treatments is also important. This aids in reimbursement, naturally, but it is also a valuable tool for tracking treatments and providing more precise communication with other healthcare providers. The codes provided here are not an exhaustive list, but they can serve as a starting point for documenting the conditions you see most in your practice.