M02.852
BillableOther reactive arthropathies, left hip
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M02.852 an HCC code?
Yes. M02.852 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 M02.852
For M02.852to 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.
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 Infections/Necrosis (HCC 92) with a community, non-dual, aged base RAF weight of 0.209. Under the older V24 model, M02.852 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 involvement may significantly impact mobility and weight-bearing; note any functional limitations in documentation. Because M02.852 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 M02.852 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
Commonly Confused Codes
- •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)
- •M25.552 — Pain in left hip (symptom vs specific arthropathy diagnosis)