FY2027
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Excludes1 pair

M12.5- vs M16.5-

M12.5 and M16.5 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.

The official note, declared on M12.5
post-traumatic osteoarthritis of hip (M16.4-M16.5)
M12.5

Traumatic arthropathy

Not billable
Chapter 13
Diseases of the musculoskeletal system and connective tissue
Section
M05-M14
M16.5

Unilateral post-traumatic osteoarthritis of hip

Not billable
Chapter 13
Diseases of the musculoskeletal system and connective tissue
Section
M15-M19
Use when the record says
  • Post-traumatic osteoarthritis of hip NOS
Indexed under
  • Osteoarthritis › post-traumatic NEC › hip
  • Osteoarthritis › hip › unilateral › post-traumatic

Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027