M05.752
BillableRheumatoid arthritis with rheumatoid factor of left hip without organ or systems involvement
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M05.752 an HCC code?
Yes. M05.752 maps to Rheumatoid Arthritis and Inflammatory Connective Tissue Disease under the CMS-HCC V28 risk adjustment model (and Rheumatoid Arthritis and Inflammatory Connective Tissue Disease 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 M05.752
For M05.752to 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 M05.752 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M05.752 is the ICD-10-CM diagnosis code for rheumatoid arthritis with rheumatoid factor of left hip without organ or systems involvement. Rheumatoid arthritis affecting the left hip with a positive rheumatoid factor blood test, without involvement of other organs or body systems. M05.752 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, M05.752 maps to Rheumatoid Arthritis and Inflammatory Connective Tissue Disease (HCC 93) with a community, non-dual, aged base RAF weight of 0.175. Under the older V24 model, M05.752 mapped to the same category but with a base RAF weight of 0.307 — 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.
Confirm left hip is documented in the clinical record. Because M05.752 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 M05.752 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm left hip is documented in the clinical record
- •Hip involvement may impact mobility and functional status; document severity if available
Clinical Significance
This code represents seropositive rheumatoid arthritis affecting the left hip without systemic involvement, indicating localized inflammatory arthritis with confirmed positive rheumatoid factor. Left hip involvement significantly impacts mobility, ambulation, and quality of life, requiring specialized management despite non-systemic nature.
Documentation Requirements
- ✓Confirmation of rheumatoid arthritis diagnosis in left hip joint
- ✓Positive rheumatoid factor laboratory test documented
- ✓Confirmation that no organ or system involvement exists
- ✓Clinical evidence of inflammatory arthritis specifically in left hip
- ✓Exclusion of extra-articular manifestations
- ✓Documentation of disease activity and functional limitation assessment
- ✓Clear identification of left hip laterality
Commonly Confused Codes
- •M05752 vs M05751 — Wrong laterality (right vs left hip)
- •M05752 vs M16.12 — M16.12 is unilateral primary osteoarthritis of left hip
- •M05752 vs M25.552 — M25.552 is pain in left hip without inflammation
- •M05752 vs M70.62 — M70.62 is trochanteric bursitis of left hip
- •M05752 vs M05.652 — M05.652 includes systemic organ involvement