Question 1

What is ICD-10 code M91.30?

Accepted Answer

M91.30 is the ICD-10-CM diagnosis code for pseudocoxalgia, unspecified hip. Hip pain that appears to originate from the hip joint but actually comes from another source like the knee or spine, with the specific hip not identified. M91.30 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering chondropathies (m91-m94).

M91.30 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 cannot be determined from documentation.

Question 2

Is M91.30 an HCC code?

Accepted Answer

No. M91.30 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 M91.30 billable?

Accepted Answer

Yes. M91.30 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. M91.30 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 M91.30?

Accepted Answer

M91.30 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 M91.30 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 M91.30?

Accepted Answer

This unspecified code should only be used when laterality cannot be determined from documentation Pseudocoxalgia is referred pain; ensure documentation clarifies the actual pain source when possible

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M91.30

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M91.30 ICD-10-CM Code: Pseudocoxalgia, unspecified hip

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M91.30

Is M91.30 an HCC code?

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