What is ICD-10 code M02.852?

M02.852 is the ICD-10-CM diagnosis code for Other reactive arthropathies, left hip. Joint inflammation in the left hip that develops as a reaction to an infection or other trigger elsewhere in the body. M02.852 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. M02.852 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. M02.852 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. M02.852 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 M02.852 map to under V28?

M02.852 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 M02.852: Other reactive

M02.852 maps to CMS-HCC V28 92. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

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Code lookupM02.852Effective 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)

M02.852

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

Other reactive arthropathies, left hip

Joint inflammation in the left hip that develops as a reaction to an infection or other trigger elsewhere in the body.

Buddy Insight

This code represents reactive arthropathy of the left hip, indicating joint inflammation triggered by a remote infectious process.

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

M02.8Other reactive arthropathies

M02.85Other reactive arthropathies, hip

M02.852Other reactive arthropathies, left hip

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for M02.852 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for M02.852 in this effective period.

Related Child Codes

Official

M02.851Other reactive arthropathies, right hip

M02.859Other reactive arthropathies, unspecified hip

Includes

Official

ICD-10-CM does not list Includes notes for M02.852 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for M02.852 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for M02.852 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for M02.852 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for M02.852 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Clinical evidence of left hip joint inflammation (pain, stiffness, reduced range of motion)

Documentation of reactive nature - inflammation secondary to remote infection

Specific anatomical location identified as left hip joint

Evidence ruling out direct septic arthritis or other infectious arthropathies

MEAT Support

HCC Buddy guidance

Clinical evidence of left hip joint inflammation (pain, stiffness, reduced range of motion)

Documentation of reactive nature - inflammation secondary to remote infection

Specific anatomical location identified as left hip joint

Evidence ruling out direct septic arthritis or other infectious arthropathies

Audit Caution

HCC Buddy guidance

Confusing reactive arthritis with direct infectious arthritis of hip joint

Missing laterality specification when documentation clearly states left hip

Using unspecified hip code when specific laterality is documented

Failing to distinguish from avascular necrosis or other hip pathology

Common Mistakes

HCC Buddy guidance

M00.052 — Staphylococcal arthritis of left hip (infectious vs reactive)

M06.052 — Rheumatoid arthritis of left hip (autoimmune vs reactive)

M16.12 — Unilateral primary osteoarthritis, left hip (degenerative vs reactive)

M02.851 — Other reactive arthropathies, right hip (laterality difference)

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 M02.852 an HCC code?

Yes. M02.852 (Other reactive arthropathies, left 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: M02.852 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: M02.852
Description: Other reactive arthropathies, left 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 M02.852 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for M02.852

For M02.852 to 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 M02.852 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

M02.852 is the ICD-10-CM diagnosis code for other reactive arthropathies, left hip. Joint inflammation in the left hip that develops as a reaction to an infection or other trigger elsewhere in the body. M02.852 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, M02.852 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 M02.852; use the applicable model and payment year when reviewing the V28 mapping. 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. 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.

Hip involvement may significantly impact mobility and weight-bearing; note any functional limitations in documentation. Because M02.852 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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 M02.852 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Hip involvement may significantly impact mobility and weight-bearing; note any functional limitations in documentation
•Ensure the triggering condition is documented and coded to support medical necessity

Clinical Significance

This code represents reactive arthropathy of the left hip, indicating joint inflammation triggered by a remote infectious process. Hip involvement is clinically critical as it affects weight-bearing capacity, mobility, and independence, requiring comprehensive management to prevent progression and maintain functional status.

Documentation Requirements

✓Clinical evidence of left hip joint inflammation (pain, stiffness, reduced range of motion)
✓Documentation of reactive nature - inflammation secondary to remote infection
✓Specific anatomical location identified as left hip joint
✓Evidence ruling out direct septic arthritis or other infectious arthropathies
✓Documentation of triggering infection or infectious process (if identified)
✓Physical examination findings consistent with hip arthritis
✓Exclusion of other arthropathy types (rheumatoid, osteoarthritis, crystal arthropathy)
✓Assessment of mobility limitations and functional impact