M25.551: Pain in right hip

The ICD-10-CM code for right hip pain when the presenting complaint or documented finding is pain in the right hip without an established specific underlying diagnosis at the time of the encounter.

Billable

FY2027

TABLE OF CONTENTS

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At a glance

Code Family

M25.55: Pain in hip.

DRG Grouping

MDC 08: DRG 555 with MCC and DRG 556 without MCC under FY2027 MS-DRG v44.

HCC Mapping (v28)

None: M25.551 does not map to an HCC in CMS-HCC v28.

Condition

Hip pain

Family Specificity

Laterality is required at the sixth character: M25.551 is the right hip, M25.552 the left, M25.559 the unspecified hip.

Which hip pain code do I assign?

Within the M25.55 subcategory the codes are separated only by side. The choice turns entirely on what the provider documented. The prior question is whether a specific hip diagnosis has been established at the encounter. If it has, that diagnosis replaces the pain code.

When documentation says…

Code

Right hip pain, no specific diagnosis established

M25.551

Use when the presenting complaint or documented finding is pain in the right hip and no specific underlying hip diagnosis has been established at the encounter. Documentation must name the right side explicitly.

Left hip pain, no specific diagnosis established

M25.552

The mirror code for the left hip, on the same terms: pain documented on the left side with no established specific diagnosis.

Hip pain, side not documented

M25.559

The residual code for hip pain when laterality is absent from the record. Check the orthopedic or primary care note for laterality. Query the provider for the side rather than defaulting to this code.

Tabular notes

EXCLUDES2: M25 CATEGORY LEVEL

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-), temporomandibular joint disorder (M26.6-) and difficulty in walking (R26.2). These notes sit on category M25 and reach M25.551 through it. An Excludes2 note means the excluded condition is not part of M25. Both codes may be reported together when the patient has both conditions.

EXCLUDES2: M25.5 SUBCATEGORY LEVEL

Pain in hand (M79.64-), pain in fingers (M79.64-), pain in foot (M79.67-), pain in toes (M79.67-) and pain in limb (subcategory M79.6). These notes sit on subcategory M25.5 and reach M25.551 through it. Pain documented in one of these sites is coded to the M79.6- codes rather than to the M25.5 joint pain codes.

NO USE ADDITIONAL, CODE FIRST OR CODE ALSO

M25.551 does not carry a mandatory tabular-level Use Additional or Code First instruction. Chapter 13 carries a general note to use an external cause code following the musculoskeletal code, if applicable, to identify the cause.

SYMPTOM CODE CONVENTION

Symptom codes including M25.551 should not be coded when the underlying condition is established and documented at the same encounter. Guideline I.B.4 accepts symptom codes when a related definitive diagnosis has not been established. Guideline I.B.5 states that signs and symptoms associated routinely with a disease process should not be assigned as additional codes. M25.551 remains appropriate for initial evaluations, when a definitive diagnosis is not yet established, or when hip pain is documented as a separate clinical concern beyond the established diagnosis.

FY2027 CHANGES

M25.551 is unchanged in the FY2027 update, effective 1 October 2026. The FY2027 codes addenda add, delete or revise no code in category M25. The FY2027 tabular addenda change no note in category M25.

Operational & financial impact

Why specificity matters beyond the chart: risk adjustment, DRG assignment and denial exposure all follow from which code is selected.

CMS-HCC v28 (PY2024+)

No HCC mapping applies. M25.551 does not map to any HCC category in CMS-HCC v28. It carried no category in v24 either.

Underlying diagnoses such as avascular necrosis or hip fracture sequelae can carry clinical and claims significance. Code those conditions whenever they are identified.

MS-DRG v44 (FY2027)

As a principal inpatient diagnosis M25.551 groups under MDC 08, diseases and disorders of the musculoskeletal system and connective tissue, to DRG 555 with MCC or DRG 556 without MCC, a two-tier structure. M25.551 can also be reported as a secondary diagnosis rather than as the principal diagnosis driving the admission.

Documentation checklist to support M25.551

Chart elements that support code selection and reduce specificity-driven denials.

Explicit laterality: the record must name the right hip. Guideline I.B.13 allows the side to come from another clinician's documentation. A record that never names the side supports M25.559.

Pain recorded as the presenting complaint or as a clinical finding at the encounter.

No established specific hip diagnosis at that encounter: if osteoarthritis, a labral tear, bursitis or avascular necrosis is diagnosed, that condition's code is assigned instead of M25.551.

The pain located to the hip joint region rather than the buttock or low back, because lumbar radiculopathy presenting as hip pain is coded under the spine and nerve categories.

A provider query on file when the documentation says only hip pain without specifying the side.

FAQ

Can M25.551 be coded alongside a hip osteoarthritis code?

M25.551 is not coded alongside a hip osteoarthritis code when the pain is part of the osteoarthritis. When right hip osteoarthritis (M16.11) is the established diagnosis, M25.551 is not separately coded. Guideline I.B.5 states that signs and symptoms associated routinely with a disease process should not be assigned as additional codes. Guideline I.B.6 allows a sign or symptom that is not routinely associated with the disease process to be coded when present.

What if the provider documents only hip pain without naming a side?

That documentation supports only M25.559, pain in unspecified hip. Laterality is almost always available in the record. The better step is to query the provider for the side and assign M25.551 or M25.552 rather than reporting the unspecified code.

Related codes

Codes in the same family as M25.551. Only codes with a published page render as links.

Sibling codes in the M25.55 family

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

Additional codes to consider

Codes outside the M25.55 family considered alongside M25.551.

Consider instead

M16.11: Unilateral primary osteoarthritis, right hip. Assign instead when right hip osteoarthritis is established.
M87.051: Idiopathic aseptic necrosis of right femur. Assign instead when avascular necrosis is documented.
M70.61: Trochanteric bursitis, right hip. Assign instead when bursitis is the documented diagnosis.

Adjacent site codes

M25.561: Pain in right knee.
M25.571: Pain in right ankle and joints of right foot.

Sources

All claims on this page derive from government and professional-standards sources.

National Center for Health Statistics. (2026). International classification of diseases, tenth revision, clinical modification (ICD-10-CM) FY2027 files. https://www.cdc.gov/nchs/icd/icd-10-cm/files.html
Centers for Medicare & Medicaid Services and National Center for Health Statistics. (2026). ICD-10-CM official guidelines for coding and reporting FY2027. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2027/ICD-10-CM-October-1-2026-FY27-Guidelines.pdf
Centers for Medicare & Medicaid Services. (2025). 2026 model software/ICD-10 mappings. https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment/2026-model-software-icd-10-mappings
Centers for Medicare & Medicaid Services. (2026). MS-DRG classifications and software, version 44. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software