ICD-10 M06.259
Billable / Specific HCC v28: 40Rheumatoid bursitis, unspecified hip
About ICD-10-CM M06.259
ICD-10-CM code M06.259 represents Rheumatoid bursitis, unspecified hip. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M06). The 2026 edition of ICD-10-CM M06.259 became effective on October 1, 2025.
Coding Tips for M06.259
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
M06.259 is a CMS-HCC v28 risk-adjustment code (category 40). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for M06.259
Local Coverage Determinations (LCDs) from CMS MACs that list M06.259 as a covered diagnosis.
Showing top 10 of 78 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing M06.259.
5 Medicare
CPT Codes Commonly Billed with M06.259
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 27134 CMS LCD: Billing and Coding: Major Joint Replacement (Hip and Knee) CMS LCD
- 27132 CMS LCD: Billing and Coding: Major Joint Replacement (Hip and Knee) CMS LCD
- 27138 CMS LCD: Billing and Coding: Major Joint Replacement (Hip and Knee) CMS LCD
- 27137 CMS LCD: Billing and Coding: Major Joint Replacement (Hip and Knee) CMS LCD
- 27487 CMS LCD: Billing and Coding: Major Joint Replacement (Hip and Knee) CMS LCD
- 27486 CMS LCD: Billing and Coding: Major Joint Replacement (Hip and Knee) CMS LCD
Convert M06.259 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| M06.259 | 7140 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To M06.259
Other codes in section M05-M14 (Inflammatory polyarthropathies).
ICD-10 M06.259, Billing FAQ
Is ICD-10 code M06.259 billable? +
Yes, M06.259 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does M06.259 affect Medicare Advantage HCC risk adjustment? +
Yes. M06.259 maps to CMS-HCC v28 category 40. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with M06.259? +
Procedures frequently paired with M06.259 include: 27134, 27132, 27138, 27137, 27487.
What ICD-9 codes does M06.259 map to? +
Per CMS GEMs, M06.259 maps to ICD-9 codes: 7140. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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