Question 1

What is ICD-10 code M65.159?

Accepted Answer

M65.159 is the ICD-10-CM diagnosis code for other infective (teno)synovitis, unspecified hip. An infection of the tendon sheath in the hip area where the specific side (left or right) is not identified. M65.159 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering disorders of synovium and tendon (m65-m67).

M65.159 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 this code only when hip tenosynovitis is documented but laterality cannot be determined.

Question 2

Is M65.159 an HCC code?

Accepted Answer

No. M65.159 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 M65.159 billable?

Accepted Answer

Yes. M65.159 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. M65.159 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

Which HCC does M65.159 map to under V28?

Accepted Answer

M65.159 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

Question 5

What does M65.159 pay in RAF?

Accepted Answer

M65.159 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

Question 6

What is the V28 vs V24 difference for M65.159?

Accepted Answer

M65.159 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 community model rewards M65.159 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 7

What documentation supports M65.159?

Accepted Answer

Use this code only when hip tenosynovitis is documented but laterality cannot be determined Query the provider or review imaging reports to determine if left or right hip is affected M65.159 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

HCC Buddy Code Card

M65.159

Is M65.159 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work M65.159 in HCC Buddy

M65.159 ICD-10-CM Code: Other infective (teno)synovitis, unspecified hip

HCC Buddy Code Card

M65.159

Is M65.159 an HCC code?

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Child Codes

Code Hierarchy

Work M65.159 in HCC Buddy