Question 1

What is ICD-10 code M25.559?

Accepted Answer

M25.559 is the ICD-10-CM diagnosis code for pain in unspecified hip. Pain in the hip joint when the specific side is not documented or is bilateral. M25.559 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering other joint disorders (m20-m25).

M25.559 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.

Use only when laterality cannot be determined from the medical record.

Question 2

Is M25.559 an HCC code?

Accepted Answer

No. M25.559 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is M25.559 billable?

Accepted Answer

Yes. M25.559 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. M25.559 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.

Question 4

What is the V28 vs V24 difference for M25.559?

Accepted Answer

M25.559 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards M25.559 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting M25.559?

Accepted Answer

Use only when laterality cannot be determined from the medical record Query the provider for clarification on which hip is affected if possible

HCC Buddy Code Card

M25.559

Is M25.559 an HCC code?

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Open M25.559 in the Interactive Encoder

M25.559 ICD-10-CM Code: Pain in unspecified hip

HCC Buddy Code Card

M25.559

Is M25.559 an HCC code?

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Open M25.559 in the Interactive Encoder