What is ICD-10 code M00.851?

M00.851 is the ICD-10-CM diagnosis code for Arthritis due to other bacteria, right hip. Bacterial infection causing inflammation and swelling in the right hip joint, caused by bacteria other than the most common types. M00.851 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. M00.851 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. M00.851 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. M00.851 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does M00.851 map to under V28?

M00.851 maps to CMS-HCC V28 HCC 92 (Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM M00.851: Arthritis due to other

M00.851 maps to CMS-HCC V28 92. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools

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Code lookupM00.851

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Infectious arthropathies (M00-M02)

M00.851

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Arthritis due to other bacteria, right hip

Bacterial infection causing inflammation and swelling in the right hip joint, caused by bacteria other than the most common types.

Buddy Insight

Bacterial arthritis of the right hip is a medical emergency that can rapidly destroy this critical weight-bearing joint.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 92

Bone/Joint/Muscle/Severe Soft...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 055

HHS-HCC 055 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 39

Bone/Joint/Muscle Infections/...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

M00.8Arthritis and polyarthritis due to other bacteria M00.85Arthritis due to other bacteria, hip M00.851Arthritis due to other bacteria, right hip

Inclusion Terms

Official

No inclusion terms are included in this display for M00.851. Check the code and parent instructions in the Code Book.

Excludes 2

Official

arthropathic psoriasis (L40.5-)Inherited from M00-M99, M00
certain conditions originating in the perinatal period (P04-P96)Inherited from M00-M99, M00
certain infectious and parasitic diseases (A00-B99)Inherited from M00-M99, M00
compartment syndrome (traumatic) (T79.A-)Inherited from M00-M99, M00
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from M00-M99, M00
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from M00-M99, M00
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from M00-M99, M00
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from M00-M99, M00
neoplasms (C00-D49)Inherited from M00-M99, M00
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from M00-M99, M00
infection and inflammatory reaction due to internal joint prosthesis (T84.5-)Inherited from M00-M99, M00

Related Codes

Official

M00.852Arthritis due to other bacteria, left hip M00.859Arthritis due to other bacteria, unspecified hip

Includes

Official

No Includes notes are included in this display for M00.851. Check the code and parent instructions in the Code Book.

Excludes 1

Official

No Excludes 1 notes are included in this display for M00.851. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for M00.851. Check the code and parent instructions in the Code Book.

Use Additional

Official

code (B96) to identify bacteriaInherited from M00.8

Code Also

Official

No Code Also instructions are included in this display for M00.851. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Confirmation of 'other bacteria' as causative organism

Specific documentation of right hip joint involvement

Microbiological evidence of bacterial infection

Clinical presentation consistent with septic arthritis

MEAT Support

HCC Buddy guidance

Confirmation of 'other bacteria' as causative organism

Specific documentation of right hip joint involvement

Microbiological evidence of bacterial infection

Clinical presentation consistent with septic arthritis

Audit Caution

HCC Buddy guidance

Confusing with osteomyelitis of adjacent bone structures

Misclassifying bacterial type when organism is specified

Incorrect laterality despite clear documentation

Coding as osteoarthritis when infection is present

Common Mistakes

HCC Buddy guidance

M00051 — Streptococcal arthritis of right hip (different organism)

M00015 — Staphylococcal arthritis of right hip (specific bacteria)

M06.851 — Other rheumatoid arthritis of right hip (autoimmune)

M16.11 — Unilateral primary osteoarthritis of right hip (degenerative)

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is M00.851 an HCC code?

Yes. M00.851 (Arthritis due to other bacteria, right hip) maps to HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.479. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: M00.851 is billable and maps to V28 HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: M00.851
Description: Arthritis due to other bacteria, right hip
HCC (V28): HCC 92 — Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
RAF reference coefficient: 0.479
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis

0.479

ESRDHCC 39, Bone/Joint/Muscle Infections/Necrosis

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work M00.851 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for M00.851

For M00.851, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

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What This Code Means

M00.851 is the ICD-10-CM diagnosis code for arthritis due to other bacteria, right hip. Bacterial infection causing inflammation and swelling in the right hip joint, caused by bacteria other than the most common types. M00.851 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, M00.851 maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis (HCC 92) with a source-labeled community, non-dual, aged reference coefficient of 0.479. No V24 mapping is shown for M00.851; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Verify the specific bacterial organism is documented; if not specified, use M00.859 instead. For M00.851, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for M00.851 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify the specific bacterial organism is documented; if not specified, use M00.859 instead
•Ensure laterality (right hip) is clearly documented in the medical record before assigning this code

Clinical Significance

Bacterial arthritis of the right hip is a medical emergency that can rapidly destroy this critical weight-bearing joint. Early diagnosis and aggressive treatment are essential to prevent permanent disability, joint replacement necessity, and life-threatening complications.