M00.051
BillableStaphylococcal arthritis, right hip
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M00.051 an HCC code?
Yes. M00.051 maps to Bone/Joint/Muscle Infections/Necrosis under the CMS-HCC V28 risk adjustment model (and Bone/Joint/Muscle Infections/Necrosis under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for M00.051
For M00.051to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed M00.051 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M00.051 is the ICD-10-CM diagnosis code for staphylococcal arthritis, right hip. A bacterial infection of the right hip joint caused by Staphylococcus bacteria, causing inflammation, pain, and potential mobility issues. M00.051 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering infectious arthropathies (m00-m02).
Under the CMS-HCC V28 risk adjustment model, M00.051 maps to Bone/Joint/Muscle Infections/Necrosis (HCC 92) with a community, non-dual, aged base RAF weight of 0.209. Under the older V24 model, M00.051 mapped to the same category but with a base RAF weight of 0.482 — V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Hip infections can be serious; verify if septic arthritis is documented and if systemic infection codes are needed. Because M00.051 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M00.051 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Hip infections can be serious; verify if septic arthritis is documented and if systemic infection codes are needed
- •Confirm right hip is clearly documented to support the '1' fifth character
Clinical Significance
Staphylococcal arthritis of the right hip is a serious bacterial joint infection (septic arthritis) requiring emergency treatment to prevent permanent joint damage. Staphylococcus is the most common causative organism in septic arthritis, and infection of the hip joint carries risks of cartilage destruction, osteomyelitis, and systemic sepsis. Accurate site-specific coding is essential for risk adjustment and reflects the high acuity and resource needs of this condition.
Documentation Requirements
- ✓Provider documentation identifying Staphylococcus as the causative organism (culture results, clinical diagnosis, or documented species)
- ✓Documentation of the affected joint with specific anatomical site
- ✓Laterality documented as right side
- ✓Clinical findings supporting joint infection (joint effusion, warmth, erythema, limited range of motion, fever)
- ✓Synovial fluid analysis results or culture and sensitivity reports when available
- ✓Treatment documentation (antibiotics, joint aspiration, surgical drainage/washout)
- ✓Assessment of whether the infection is acute or chronic, and whether it is a primary infection or secondary to another source
Commonly Confused Codes
- •M00.15x — Pneumococcal arthritis of same joint site; differs by causative organism (Pneumococcus vs. Staphylococcus)
- •M00.25x — Streptococcal arthritis of same joint site; differs by causative organism (Streptococcus vs. Staphylococcus)
- •M00.85x — Arthritis due to other bacteria at same joint site; use when organism is identified but not Staphylococcus
- •M00.9 — Pyogenic arthritis, unspecified; use only when causative organism cannot be identified