ICD-10 · PDGM grouping
M16 Osteoarthritis of hip
All 15 codes in the M16 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.
Codes in family
15
Can lead a claim
11
Cannot lead a claim
4
What CMS assigns to M16
11 of the 15 codes group to Musculoskeletal Rehabilitation; 4 are assigned no clinical group. None of the 15 is assigned a comorbidity subgroup. 11 of the 15 can lead a claim.
Every code in M16
Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.
| Code | Description | Primary position | Clinical group | Comorbidity subgroup |
|---|---|---|---|---|
| M16.0 | Bilateral primary osteoarthritis of hip | Can lead a claim | E | None |
| M16.1 Unilateral primary osteoarthritis of hip | ||||
| M16.10 | Unilateral primary osteoarthritis, unspecified hip | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| M16.11 | Unilateral primary osteoarthritis, right hip | Can lead a claim | E | None |
| M16.12 | Unilateral primary osteoarthritis, left hip | Can lead a claim | E | None |
| M16.2 | Bilateral osteoarthritis resulting from hip dysplasia | Can lead a claim | E | None |
| M16.3 Unilateral osteoarthritis resulting from hip dysplasia | ||||
| M16.30 | Unilateral osteoarthritis resulting from hip dysplasia, unspecified hipCMS: Unilateral osteoarth resulting from hip dysplasia, unsp hip | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| M16.31 | Unilateral osteoarthritis resulting from hip dysplasia, right hipCMS: Unilateral osteoarth resulting from hip dysplasia, right hip | Can lead a claim | E | None |
| M16.32 | Unilateral osteoarthritis resulting from hip dysplasia, left hipCMS: Unilateral osteoarth resulting from hip dysplasia, left hip | Can lead a claim | E | None |
| M16.4 | Bilateral post-traumatic osteoarthritis of hip | Can lead a claim | E | None |
| M16.5 Unilateral post-traumatic osteoarthritis of hip | ||||
| M16.50 | Unilateral post-traumatic osteoarthritis, unspecified hip | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| M16.51 | Unilateral post-traumatic osteoarthritis, right hip | Can lead a claim | E | None |
| M16.52 | Unilateral post-traumatic osteoarthritis, left hip | Can lead a claim | E | None |
| M16.6 | Other bilateral secondary osteoarthritis of hip | Can lead a claim | E | None |
| M16.7 | Other unilateral secondary osteoarthritis of hip | Can lead a claim | E | None |
| M16.9 | Osteoarthritis of hip, unspecified | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.
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