The ICD-10-CM system does not offer a single code for bilateral hip pain as a standalone symptom. Instead, standard coding practice calls for reporting two codes together: M25.551 (pain in right hip) and M25.552 (pain in left hip). That pairing captures the bilateral nature of the complaint within a classification system that, for joint pain specifically, splits everything by side rather than providing a combined option. The situation gets more interesting when you move beyond the symptom of pain to the underlying diagnosis, because several hip conditions do have dedicated bilateral codes built right in.
How M25.55x Works for Hip Pain
Joint pain lives under category M25.5 in ICD-10-CM, and hip pain specifically falls under M25.55-. The seventh character (the final digit) tells the system which side is affected. M25.551 is the right hip, M25.552 is the left hip, and M25.559 covers an unspecified hip when the side isn’t documented. There is no M25.553 for “bilateral” the way you’d find for some musculoskeletal diagnoses. When your provider documents bilateral hip pain, a coder assigns both M25.551 and M25.552 on the same claim or encounter record. The first-listed code is typically the side identified as the primary reason for the visit, or whichever side is more symptomatic.
This matters for a few practical reasons. Insurance systems process each code independently, so having two codes rather than one can affect how the encounter is classified and reimbursed. It also means that if a coder mistakenly uses only M25.559 (unspecified) instead of assigning both sided codes, the record loses the detail that both hips are involved. Using M25.559 when laterality is known is a common coding error and one that auditors flag, since ICD-10 guidelines generally require the most specific code available.
Why Some Hip Conditions Have Bilateral Codes and Others Don’t
The absence of a bilateral option for hip joint pain feels like an oversight when you realize that plenty of other hip-related diagnoses do include one. Bilateral primary osteoarthritis of the hip has its own single code, M16.0. Idiopathic avascular necrosis of both femoral heads is captured by M87.052. Bilateral congenital dislocation of the hip is Q65.1. The pattern is that definitive diagnoses with well-defined bilateral presentations tend to get their own bilateral code, while symptom codes like joint pain often do not.
The reason is partly historical and partly structural. When the World Health Organization designed ICD-10, and the U.S. adapted it into ICD-10-CM, the system expanded from roughly 14,000 codes under ICD-9 to close to 70,000. Even with that expansion, not every possible laterality combination received its own entry. Symptom codes were lower priority for bilateral designations because the expectation is that symptoms will eventually be replaced by a definitive diagnosis code, which is more likely to have the bilateral option.
When a More Specific Diagnosis Code Replaces the Pain Code
In most clinical workflows, M25.551 and M25.552 serve as placeholder codes. They document the reason for the visit before diagnostic workup is complete. Once imaging, lab work, or clinical examination identifies a cause, the pain codes are typically replaced by a code for the underlying condition. This swap matters because diagnosis codes carry more weight in treatment authorization and because they more accurately reflect what is happening.
Some of the most common definitive diagnoses behind bilateral hip pain include:
- Bilateral hip osteoarthritis (M16.0): The single most frequent cause of chronic bilateral hip pain in adults, coded with one bilateral code rather than two sided codes.
- Avascular necrosis of both femoral heads (M87.05-): This condition has bilateral options within its code set. Case reports have documented bilateral avascular necrosis presenting with bilateral hip pain in patients as young as their mid-twenties, sometimes linked to underlying metabolic disease.1PubMed Central. Avascular necrosis of bilateral femoral heads in a patient with Fabry’s disease
- Rheumatoid arthritis of both hips (M05.x or M06.x): Rheumatoid arthritis tends to be symmetric, making bilateral hip involvement common. The code structure varies based on whether rheumatoid factor is present.
- Bilateral trochanteric bursitis (M70.62): Pain felt on the outer aspect of both hips, with a dedicated bilateral code available.
The distinction between a symptom code and a diagnosis code is not just academic. If a provider submits M25.551 and M25.552 on repeated visits over many months without ever progressing to a definitive diagnosis code, payers may question the medical necessity of continued treatment. The pain codes are meant to be transitional.
Bilateral Hip Pain in Children and Adolescents
Bilateral hip pain in younger patients raises a different set of diagnostic possibilities and therefore a different set of codes. Slipped capital femoral epiphysis, where the growth plate at the top of the thighbone shifts out of place, is one condition that can affect both hips. A study of children under ten who developed this condition found that all of them had body mass indices above the 97th percentile for their age, and about a fifth had bilateral involvement.2Europe PMC. Early onset slipped capital femoral epiphysis in children under 10 years old. Surgical treatment with two different methods and results. ICD-10-CM captures bilateral slipped epiphysis under M93.003.
Legg-Calvé-Perthes disease, a childhood condition where blood supply to the femoral head is temporarily disrupted, can also present bilaterally. It has its own bilateral code under M91.1-. Developmental dysplasia of the hip, often caught in infancy, uses bilateral codes under Q65. For pediatric patients, the stakes of correct bilateral coding are particularly high because these conditions may require surgical intervention, and payers scrutinize laterality closely when authorizing procedures.
Common Coding Mistakes With Bilateral Hip Pain
Several errors come up repeatedly in billing audits and coding reviews when bilateral hip pain is involved.
The first is using M25.559 (unspecified hip) when the medical record clearly documents both sides. ICD-10 guidelines are explicit that you should code to the highest level of specificity supported by the documentation. If the note says “bilateral hip pain,” M25.559 understates the information available, and two lateralized codes should be used instead.
The second is reporting a bilateral diagnosis code alongside a unilateral pain code for the same hip. For example, if a patient has bilateral hip osteoarthritis (M16.0) and the provider also documents hip pain, adding M25.551 or M25.552 is generally unnecessary because pain is an inherent feature of the arthritis diagnosis. Stacking a symptom code on top of a diagnosis code that already implies the symptom can trigger denials or audit flags.
The third is failing to sequence the codes properly when one hip is the primary complaint. If a patient comes in because the left hip has gotten significantly worse even though both hurt, M25.552 should be listed first, with M25.551 as a secondary code. Sequencing affects which diagnosis drives reimbursement and clinical decision-making.
The Transition From ICD-9 to ICD-10 and Its Effect on Pain Coding
The United States switched from ICD-9-CM to ICD-10-CM in October 2015, and the transition had real consequences for how pain conditions were tracked in large databases. Under ICD-9, hip pain was captured with far less specificity, and laterality was often absent from the code itself. A study that built a crosswalk between the two systems to track patients with common pain conditions found that the overall rates of pain-related encounters stayed remarkably stable across the transition, with differences within a few percentage points between the ICD-9 and ICD-10 periods across three large health systems.3The Journal of Pain. Development and Assessment of a Crosswalk Between ICD-9-CM and ICD-10-CM to Identify Patients with Common Pain Conditions
That consistency is reassuring for researchers who need to study pain trends spanning both coding eras, but it masks some real changes at the individual code level. Under ICD-9, a coder might use 719.45 (pain in joint, pelvic region and thigh) for any hip pain without specifying side. Under ICD-10, that single code exploded into multiple options requiring laterality. Practices that had never needed to document which hip was painful suddenly had to do so, and many struggled with the change in the first year or two after implementation.
How Documentation Drives Code Selection
The code a coder selects depends entirely on what the clinician writes in the medical record. If a surgeon’s note says “patient presents with bilateral hip pain, likely degenerative,” the coder can assign M25.551 and M25.552 for the pain, but cannot jump to a bilateral osteoarthritis code without a confirmed diagnosis. If the same surgeon writes “bilateral hip osteoarthritis with pain,” the coder uses M16.0 and typically does not add the pain codes separately.
This creates a practical issue: a provider who is a thorough documentor and a provider who writes sparse notes may generate very different code profiles for clinically identical patients. Coders are bound by what the record says, not by what they believe the diagnosis to be. In settings with clinical documentation improvement programs, staff specifically query providers to add laterality and diagnostic specificity so that the resulting codes are as accurate as possible. For bilateral hip pain specifically, the query is often as simple as asking whether the pain is on the right, left, or both sides, since many providers write “hip pain” without specifying.
Bilateral Hip Pain After Joint Replacement
Patients who have had hip replacement surgery on one or both sides present a unique coding challenge when they report bilateral hip pain. If the pain is coming from the prosthetic joint, the correct codes fall under the T84 category for mechanical complications of internal orthopedic devices, or under M97 for periprosthetic fracture. If the pain is from the native (non-replaced) hip on the opposite side, the standard M25.55- codes or a diagnosis-specific code applies to that side, while the prosthetic side gets its own complication code.
If both hips have been replaced and both are painful, the coding gets layered. Each side needs its own complication code specifying the type of problem (loosening, infection, wear, periprosthetic fracture) and which side is affected. A patient experiencing bilateral pain after bilateral total hip arthroplasty might end up with four or five codes on a single encounter: a complication code for each hip, a code for the specific type of complication if it differs by side, and possibly additional codes for contributing factors like obesity or osteoporosis.
What ICD-11 May Change
The World Health Organization released ICD-11 in 2019, and countries are gradually adopting it, though the United States has not yet set a mandatory transition date. One of the major structural changes in ICD-11 is a feature called postcoordination, which allows coders to link multiple code components together into a single cluster describing a clinical concept in much more detail than ICD-10 permits.4PubMed Central. Postcoordination of codes in ICD-11
For bilateral hip pain, postcoordination could mean that instead of assigning two separate lateralized codes, a coder would build a single compound code specifying the body site (hip joint), the clinical finding (pain), and the laterality (bilateral) all linked together. This approach would eliminate the workaround of assigning two codes for one bilateral problem and would make database searches for bilateral conditions much simpler. Under ICD-10, finding all patients with bilateral hip pain in a database requires searching for records that contain both M25.551 and M25.552 on the same encounter, which is clunky and can miss cases where the codes were entered on separate visits. A unified postcoordinated code would solve that.
The timeline for ICD-11 adoption in the United States remains unclear, and the transition will likely take years of preparation once a date is announced. For the foreseeable future, M25.551 and M25.552 remain the standard codes to reach for when documenting bilateral hip pain as a symptom, with more specific bilateral diagnosis codes taking over once the underlying cause is identified.
Conditions That Mimic Bilateral Hip Pain
Not all pain felt in both hips actually originates from the hip joints. Referred pain from the lumbar spine is one of the most common mimics. Disc herniation, spinal stenosis, or sacroiliac joint dysfunction can produce pain perceived in the hip region bilaterally, but the correct ICD-10 codes would point to the spine rather than the hip. Lumbar radiculopathy, for instance, is coded under M54.1-, and sacroiliac dysfunction under M53.3. Using hip pain codes for what is actually a spinal problem misrepresents the clinical picture and can lead to inappropriate treatment authorizations.
Vascular claudication from peripheral artery disease is another condition that sometimes presents as bilateral hip or buttock pain, particularly with walking. The codes for that fall under the I70 category for atherosclerosis of the extremities. Fibromyalgia, coded as M79.7, can also cause widespread pain that includes both hips as part of a broader pain syndrome. In each of these cases, using the hip pain codes rather than the codes for the true underlying condition would be a coding error once the diagnosis is established, even though the patient’s complaint on intake may have been straightforwardly described as bilateral hip pain.