M12.859
BillableOther specific arthropathies, not elsewhere classified, unspecified hip
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M12.859 an HCC code?
No. M12.859 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
M12.859 is the ICD-10-CM diagnosis code for other specific arthropathies, not elsewhere classified, unspecified hip. A joint condition affecting the hip that doesn't fit into other specific arthropathy categories, with the side not specified. M12.859 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).
M12.859 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This unspecified code should only be used when laterality is not documented or cannot be determined.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M12.859 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This unspecified code should only be used when laterality is not documented or cannot be determined
- •Query the provider to determine if left or right hip involvement can be documented for specificity