M16.4 — Bilateral post-traumatic osteoarthritis of hip
M16.4 is a billable, specific ICD-10-CM code for bilateral post-traumatic osteoarthritis of hip. It is valid for submission on a claim.
Other codes that can never be billed with M16.4
These codes carry an Excludes1 note pointing at M16.4. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading M16.4 alone.
- M12.5Traumatic arthropathy
Risk adjustment
M16.4 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
M16.4 is named in 23 Medicare coverage policies — 17 listing it as supporting medical necessity, and 6 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A58893Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A59374Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
- A59434Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
How M16.4 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to M16.4.
- Osteoarthritis›hip›bilateral›post-traumatic
- Osteoarthritis›post-traumatic NEC›hip›bilateral
Related codes at this level
Codes that share M16. If M16.4 is not quite right, the correct code is usually one of these.
- M16.0Bilateral primary osteoarthritis of hip
- M16.1Unilateral primary osteoarthritis of hip
- M16.2Bilateral osteoarthritis resulting from hip dysplasia
- M16.3Unilateral osteoarthritis resulting from hip dysplasia
- M16.5Unilateral post-traumatic osteoarthritis of hip
- M16.6Other bilateral secondary osteoarthritis of hip
- M16.7Other unilateral secondary osteoarthritis of hip
- M16.9Osteoarthritis of hip, unspecified
Questions about M16.4
- Is M16.4 a billable ICD-10-CM code?
- Yes. M16.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M16.4 sit in the tabular list?
- Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Osteoarthritis (M15-M19).