Wiki diagnosis code hip pain please !!

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Code: M25.552


B]Code Name[/B]: ICD-10 Code for Pain in left hip

Block: Other joint disorders (M20-M25)

Details: Pain in left hip
M25.5

Excludes2: pain in hand (M79.64-)
pain in fingers (M79.64-)
pain in foot (M79.67-)
pain in limb (M79.6-)
pain in toes (M79.67-)
M25

Excludes2: abnormality of gait and mobility (R26.-)
acquired deformities of limb (M20-M21)
calcification of bursa (M71.4-)
calcification of shoulder (joint) (M75.3)
calcification of tendon (M65.2-)
difficulty in walking (R26.2)
temporomandibular joint disorder (M26.6-)

Guidelines: Diseases of the musculoskeletal system and connective tissue (M00-M99)

Note: Use an external cause code following the code for the musculoskeletal condition, if applicable, to identify the cause of the musculoskeletal condition

Excludes 2: arthropathic psoriasis (L40.5-)
certain conditions originating in the perinatal period (P04-P96)
certain infectious and parasitic diseases (A00-B99)
compartment syndrome (traumatic) (T79.A-)
complications of pregnancy, childbirth and the puerperium (O00-O9A)
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
endocrine, nutritional and metabolic diseases (E00-E88)
injury, poisoning and certain other consequences of external causes (S00-T88)
neoplasms (C00-D49)
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

For more details on M25.552, ICD-10 Code for Pain in left hip, visit: https://coder.aapc.com/icd-10-codes/M25.552

MsMaddy

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THE BLUE SHIELD INS IS REJECTING A CLAIM BECAUSE THEy SAID 719.45 HIP PAIN IS A INJURY CODE AND THEY ANT THE DATE OF INJURY AND HOW IT OCCURED. BUT THE PT WAS NOT INJURED AND HE HAS VARIUS JOINT ACHES AND PAIN PER DOCTORS NOTE. HE ALSO DIAGNOSIS THE PT WITH MULTIPLE ARTHRALGIA AND THE PT IS ONLY 7 YRS OLD.
IS THERE SOMETHING NEW WITH JOINT PAIN CODES? I ALSO HAD A CLAIM REJECTION
ON SHOULDER PAIN DX 719.41.

THANK YOU IN ADVANCE
MSMADDY :eek:
 
Last edited:
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Arthralgia literally means joint pain.....

Multiple Arthralgia would mean Joint pain in multiple joints....

The coding guideline is as follows...." Do not code symptoms if there is a definite diagnosis" . If you have coded Arthralgia I would say Hip pain is included under it and therefore they would not pay for it as it is double dipping.....

This is why your claims are getting rejected.... Although I am not a pro at billing any suggestions please..... I would want to know everybody's input.

Thanks
 

akandrew

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Joint Pain

Hello-

First of all, as you know, 719.45 is not an injury code. The insurance company is wrong by saying that. I think they are looking for a more definitive diagnosis and it is totally acceptable to use that code if the doctor is still trying to figure out what is causing the joint pain. I do billing and coding and more than likely, the insurance company will send a questionnaire to the patient's parents to fill out. My husband had shoulder pain and we received a questionnaire from the insurance company asking if it was due to an accident. It was not due to an accident. You might want to start submitting your claims by entering the first date the patient was seen for the joint pain on future claims to see if that helps. It might also help to resubmit or appeal the claim with dx code 719.49 for multiple joint pain since you said he has various joint aches. That would be the appropriate code to use in this case.

Unfortunately, you will have to appeal the rejection since it has already been processed which takes time. Good luck!
 

eadun2000

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THE BLUE SHIELD INS IS REJECTING A CLAIM BECAUSE THEy SAID 719.45 HIP PAIN IS A INJURY CODE AND THEY ANT THE DATE OF INJURY AND HOW IT OCCURED. BUT THE PT WAS NOT INJURED AND HE HAS VARIUS JOINT ACHES AND PAIN PER DOCTORS NOTE. HE ALSO DIAGNOSIS THE PT WITH MULTIPLE ARTHRALGIA AND THE PT IS ONLY 7 YRS OLD.
IS THERE SOMETHING NEW WITH JOINT PAIN CODES? I ALSO HAD A CLAIM REJECTION
ON SHOULDER PAIN DX 719.41.

THANK YOU IN ADVANCE
MSMADDY :eek:
I have no clue! Ummmm 959.6 is an INJURY code... 843.9 is an INJURY code, but 719.45 DEFINITELY is not an injury code. Wow. Have you called and talked to them? I so miss doing the billing with coding. There is no reason to need an e code and doi on a joint pain code. Now, if there is a sprain or mechanism of injury, then I get that, but this is a pain code.... arrgggg. Why do insurance companies have to make things so hard when it is so very straight forward?
 
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