ICD 10 Code for Left Hip Pain: A Complete Clinical & Billing Guide

Hip pain is a common musculoskeletal complaint seen in primary care, orthopedics, emergency departments, and physical therapy clinics across the United States. When a patient presents with pain specifically in the left hip, providers and medical coders must assign the correct ICD-10-CM diagnosis code to support accurate documentation, medical necessity, and reimbursement.

The correct ICD-10 code for left hip pain is M25.552 – Pain in left hip.

Using the wrong diagnosis code, failing to document laterality, or continuing to bill a symptom code after a confirmed diagnosis can lead to:

• Claim denials
• Compliance risks
• Insurance audits
• Lost reimbursement

This guide explains how to code left hip pain correctly, including code structure, clinical causes, documentation requirements, and billing guidelines used by providers and revenue cycle teams.

What Is ICD-10-CM and Why Does Laterality Matter?

ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) is the diagnostic coding system used in the United States for physician offices, outpatient clinics, hospitals, and rehabilitation facilities.

The code set is maintained by:

• Centers for Medicare & Medicaid Services (CMS)
• National Center for Health Statistics (NCHS)

One major improvement in ICD-10-CM compared with ICD-9 is laterality.

Laterality allows coders to specify whether a condition affects:

• Left side
• Right side
• Bilateral
• Unspecified side

For musculoskeletal diagnoses such as hip pain, payers expect the correct side to be documented whenever clinical documentation supports it.

Failure to code laterality often results in the use of unspecified diagnosis codes, which increases audit risk and may weaken medical necessity.

Primary ICD 10 Code for Left Hip Pain

The primary ICD 10 code for left hip pain is:

• M25.552 – Pain in left hip

This code is found in Chapter 13 of ICD-10-CM, which covers diseases of the musculoskeletal system and connective tissue. It falls under the subcategory M25.5 (Pain in joint), which is further divided by joint location and laterality.

Use M25.552 when the clinical documentation supports left-sided hip pain without a more specific underlying diagnosis. If imaging or workup reveals a more definitive cause, such as osteoarthritis or a fracture, you should code the specific condition instead.

ICD-10-CM Code Structure for Left Hip Pain

Understanding the code structure helps coders and billers avoid errors:

Common Causes of Left Hip Pain and Their Codes

Left hip pain can stem from many underlying conditions. Each condition has its own ICD-10-CM code. The ICD 10 code for left hip pain (M25.552) is appropriate only when no more specific diagnosis has been established.

Osteoarthritis of the Left Hip

Osteoarthritis (OA) is the most common joint disease in the United States. According to the CDC, an estimated 33 million U.S. adults have OA. When OA affects the left hip and is confirmed clinically or radiographically, use:

• M16.12: Unilateral primary osteoarthritis, left hip
• M16.32: Unilateral post-traumatic osteoarthritis, left hip

Left Hip Fractures

Hip fractures are a major public health concern, especially among older adults. The CDC reports that more than 300,000 adults aged 65+ are hospitalized each year for hip fractures. Fractures of the left hip are coded with specificity based on the fracture site and type:

• S72.002A – Fracture of unspecified part of neck of left femur, initial encounter
• S72.141A – Displaced intertrochanteric fracture of left femur, initial encounter

Trochanteric Bursitis of the Left Hip

Bursitis of the left hip is a common pain diagnosis in middle-aged and older adults. The correct code is:

• M70.62 – Trochanteric bursitis, left hip

This condition is often misdiagnosed or confused with OA. Accurate documentation helps distinguish the two.

Left Hip Labral Tear

• M24.152 – Loose body in left hip (when accompanied by loose body)
• S73.002A – Unspecified subluxation of left hip joint, initial encounter

For labral tears, many coders use M24.852 (Other specific joint derangements of left hip) or consult the provider for the most appropriate code based on operative findings.

ICD 10 Code for Left Hip Pain: Documentation Requirements

Accurate coding starts with accurate documentation. For the ICD 10 code for left hip pain to be assigned correctly, the provider’s notes should include:

• Specific location: left hip, groin, or lateral thigh
• Laterality is clearly stated as ‘left.’
• Onset, duration, and aggravating or relieving factors
• Any prior diagnoses, imaging results, or surgical history
• Assessment: final diagnosis or working diagnosis

Without clear documentation, coders must default to the unspecified code (M25.559), which can result in lower reimbursement and higher audit risk.

Coding Guidelines: Principal vs. Additional Diagnoses

When coding left hip pain, follow these ICD-10-CM guidelines:

• If the pain is a symptom of an established diagnosis (e.g., hip OA), code only the underlying condition, not the pain separately.
• If the cause of pain is not yet determined, code the pain symptom (M25.552) as the principal diagnosis.
• Additional codes may be used for related conditions such as muscle weakness, limited range of motion, or comorbidities.

Medicare Billing Considerations for Left Hip Pain

Medicare is the largest payer for hip-related diagnoses in the U.S., particularly for patients aged 65 and older. When submitting claims for left hip pain to Medicare:

• Ensure the ICD-10-CM code supports medical necessity for the service billed.
• For imaging orders (X-ray, MRI), the code must match the clinical indication documented.
• Physical therapy claims require a referral diagnosis that matches the therapy plan of care.
• Avoid using the unspecified code (M25.559) when the patient’s record clearly indicates the left side.

Avoiding Common Coding Errors

Coders frequently make these mistakes with hip pain codes:

• Using M25.559 (unspecified) instead of M25.552 (left hip), always check documentation for laterality.
• Coding pain as a secondary diagnosis when it is actually the primary reason for the visit.
• Failing to code the underlying cause once it has been established (e.g., continuing to code pain after a hip OA diagnosis is documented).
• Using fracture codes for chronic conditions, fracture codes have episode-of-care suffixes (A, D, S) that must be applied correctly.

ICD 10 Code for Left Hip Pain in Physical Therapy Settings

Physical therapists and their billing staff frequently encounter the ICD 10 code for left hip pain. PT claims require a physician referral with an ICD-10 diagnosis code. The most used codes in PT for hip pain include M25.552, M16.12, and M70.62.

According to the American Physical Therapy Association, hip pain is among the top five musculoskeletal complaints treated in outpatient PT. Proper coding ensures the plan of care is covered under Medicare Part B and commercial insurance plans.

Frequently Asked Questions

1. Can I use M25.552 if the patient has both left and right hip pain?

No. If both hips are painful, you should code both sides: M25.551 for the right hip and M25.552 for the left hip. ICD-10-CM allows bilateral coding, but there is no single bilateral code for hip pain; you must code each side separately.

2. What is the difference between M25.552 and M16.12?

M25.552 is a symptom code for left hip pain without a confirmed specific cause. M16.12 is a specific disease code for unilateral primary osteoarthritis of the left hip. Once OA is confirmed, use M16.12 and do not separately code the pain.

3. Is M25.552 acceptable for outpatient hospital billing?

Yes. M25.552 can be used in outpatient hospitals, physician offices, urgent care, and other settings. For inpatient billing, the UHDDS guidelines require coding the condition to the highest degree of certainty known at discharge.

4. How do I code left hip pain caused by a work injury?

You still use M25.552 or a more specific code for the condition. Additionally, assign an external cause code from the W, X, Y chapter to describe the mechanism of injury. A workers’ compensation claim will also require a first report of injury form in most states.

5. What CPT codes are typically paired with M25.552?

Common CPT codes billed with M25.552 include 99213–99215 (office visits), 73720 (MRI hip without contrast), 73510 (X-ray hip minimum 2 views), and 20610 (injection of major joint). The ICD-10 diagnosis must support medical necessity for each CPT code billed.

Get Expert Help with Medical Coding and Revenue Cycle Management

Accurate use of the ICD 10 code for left hip pain (M25.552) is essential for clean claims, proper reimbursement, and compliance. If your practice struggles with coding errors, documentation gaps, or payer rejections, professional billing support can make a significant difference. 

Contact Tennessee medical billing to see how our experts help providers improve coding accuracy, reduce denials, and streamline revenue cycle management. Let our team handle the billing complexity so you can focus on patient care.