ICD-10 M12.052
Billable / Specific HCC v28: 40Chronic postrheumatic arthropathy [Jaccoud], left hip
About ICD-10-CM M12.052
ICD-10-CM code M12.052 represents Chronic postrheumatic arthropathy [Jaccoud], left hip. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M12). The 2026 edition of ICD-10-CM M12.052 became effective on October 1, 2025.
Coding Tips for M12.052
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
M12.052 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 M12.052
Local Coverage Determinations (LCDs) from CMS MACs that list M12.052 as a covered diagnosis.
Showing top 10 of 318 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing M12.052.
5 Medicare
CPT Codes Commonly Billed with M12.052
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert M12.052 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 |
|---|---|---|
| M12.052 | 7144 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To M12.052
Other codes in section M05-M14 (Inflammatory polyarthropathies).
ICD-10 M12.052, Billing FAQ
Is ICD-10 code M12.052 billable? +
Yes, M12.052 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does M12.052 affect Medicare Advantage HCC risk adjustment? +
Yes. M12.052 maps to CMS-HCC v28 category 40. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does M12.052 map to? +
Per CMS GEMs, M12.052 maps to ICD-9 codes: 7144. 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 May 31, 2026.
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