M01.X59 ICD-10-CM Code: Direct infection of unspecified hip in infectious and parasitic diseases classified elsewhere

Code

M01.X59

Description

Direct infection of unspecified hip in infectious and parasitic diseases classified elsewhere

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

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 M01.X59 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for M01.X59

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for M01.X59 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Use this code when hip laterality is not documented or when bilateral hip involvement is present
• •Requires a secondary code to identify the underlying infectious or parasitic disease causing the joint infection

Clinical Significance

This code captures direct hip joint infection secondary to classified infectious or parasitic diseases when laterality is not documented, representing incomplete clinical documentation. Hip infections are particularly serious due to the joint's weight-bearing function and risk for rapid progression to systemic complications.

Documentation Requirements

• ✓Documentation of hip joint infection without laterality specification
• ✓Required underlying infectious or parasitic disease code as primary diagnosis
• ✓Evidence that hip infection is direct extension of classified disease
• ✓Clinical examination findings consistent with infectious hip arthropathy
• ✓Laboratory markers supporting infectious and inflammatory processes
• ✓Imaging studies demonstrating hip joint involvement and complications
• ✓Microbiological studies from joint aspiration when performed
• ✓Treatment protocol addressing both systemic infection and hip joint preservation

Commonly Confused Codes

• •M00.959: Pyogenic arthritis, unspecified hip (bacterial infection not from classified disease)
• •M25.559: Pain in unspecified hip (joint symptoms without infectious cause)
• •M01.X51: Direct infection of right hip (when laterality is actually documented)
• •M01.X52: Direct infection of left hip (when laterality is actually documented)

Child Codes