M05.151 ICD-10-CM Code: Rheumatoid lung disease with rheumatoid arthritis of right hip
M05.151 maps to CMS-HCC V28 93. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Inflammatory polyarthropathies (M05-M14)
M05.151
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceRheumatoid lung disease with rheumatoid arthritis of right hip
Rheumatoid arthritis of the right hip combined with lung disease caused by the rheumatoid condition.
Buddy Insight
Indicates severe rheumatoid arthritis with right hip involvement and concurrent pulmonary manifestations, representing advanced systemic disease with significant mobility and respiratory impact.
CMS-HCC V28
MappedHCC 93
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 056
Code-level coefficient reference
ESRD/PACE
MappedHCC 40
Code-level coefficient reference
RXHCC
MappedHCC 83
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for M05.151 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M05.151 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M05.151 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for M05.151 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M05.151 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for M05.151 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for M05.151 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 M05.151 an HCC code?
Yes. M05.151 (Rheumatoid lung disease with rheumatoid arthritis of right hip) maps to HCC 93, Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.617. 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: M05.151 is billable and maps to V28 HCC 93, Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- M05.151
- Description
- Rheumatoid lung disease with rheumatoid arthritis of right hip
- HCC (V28)
- HCC 93 — Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders
- RAF reference coefficient
- 0.617
- 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 M05.151 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT Criteria for M05.151
For M05.151 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 M05.151 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
M05.151 is the ICD-10-CM diagnosis code for rheumatoid lung disease with rheumatoid arthritis of right hip. Rheumatoid arthritis of the right hip combined with lung disease caused by the rheumatoid condition. M05.151 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering inflammatory polyarthropathies (m05-m14).
Under the CMS-HCC V28 risk adjustment model, M05.151 maps to Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders (HCC 93) with a source-labeled community, non-dual, aged reference coefficient of 0.617. No V24 mapping is shown for M05.151; 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.
Confirm right hip is the affected joint; this code is specific to the right side only. Because M05.151 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 M05.151 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm right hip is the affected joint; this code is specific to the right side only
- •Document hip involvement severity and any functional limitations along with pulmonary findings
Clinical Significance
Indicates severe rheumatoid arthritis with right hip involvement and concurrent pulmonary manifestations, representing advanced systemic disease with significant mobility and respiratory impact. This condition requires intensive management due to the weight-bearing joint involvement and extra-articular complications.
Documentation Requirements
- ✓Confirmed rheumatoid arthritis with positive laboratory findings
- ✓Documentation of right hip joint involvement with inflammatory changes
- ✓Evidence of rheumatoid-related lung disease through appropriate studies
- ✓Specific notation of right-sided hip involvement
- ✓Clinical assessment linking lung pathology to rheumatoid etiology
- ✓Functional mobility assessment and pain evaluation
- ✓Treatment plan addressing both hip preservation and pulmonary management
Commonly Confused Codes
- •M05.152: Rheumatoid lung disease with RA of left hip (different laterality)
- •M05.159: Rheumatoid lung disease with RA of unspecified hip (laterality not documented)
- •M06.051: Rheumatoid arthritis of right hip without lung involvement
- •M05.161: Rheumatoid lung disease with RA of right knee (different joint)
- •M05.141: Rheumatoid lung disease with RA of right hand (different anatomical location)