M02.159
BillablePostdysenteric arthropathy, unspecified hip
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M02.159 an HCC code?
Yes. M02.159 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 M02.159
For M02.159to 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 M02.159 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M02.159 is the ICD-10-CM diagnosis code for postdysenteric arthropathy, unspecified hip. Joint inflammation and pain in the hip (side not specified) that develops after a dysentery infection. M02.159 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, M02.159 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, M02.159 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.
Use only when laterality cannot be determined from available documentation. Because M02.159 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 M02.159 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use only when laterality cannot be determined from available documentation
- •Attempt to clarify with provider whether right, left, or bilateral hip involvement exists
Clinical Significance
Postdysenteric arthropathy affecting the hip without specified laterality represents a chronic reactive arthritis that can severely impact mobility and weight-bearing function. While laterality is unspecified, this condition still requires comprehensive management due to its potential for significant disability following dysentery infection.
Documentation Requirements
- ✓History of dysentery or infectious diarrheal illness documented
- ✓Hip joint involvement without laterality specification
- ✓Evidence of arthropathy symptoms affecting hip function
- ✓Post-infectious temporal relationship established
- ✓Chronic or persistent nature of joint inflammation
- ✓Mobility and functional assessment documented
- ✓Physical findings consistent with hip arthritis
Commonly Confused Codes
- •M02.151 — Postdysenteric arthropathy, right hip (use when right side documented)
- •M02.152 — Postdysenteric arthropathy, left hip (use when left side documented)
- •M02.161 — Postdysenteric arthropathy, right knee (different joint location)
- •M00.059 — Staphylococcal arthritis, unspecified hip (septic arthritis)
- •M25.559 — Pain in unspecified hip (symptom, not diagnosis)