M25.00 — Hemarthrosis, unspecified joint
Is M25.00 billable?
Yes, but M25.00 will trip a Medicare edit. M25.00 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists M25.00 under Medicare Code Editor edit 20, “Unspecified code” — meaning a code specifying laterality (right, left or bilateral) exists in the same family. On an inpatient claim this triggers the edit, because CMS holds that there are very limited circumstances in which laterality cannot be documented.
M25.00 at a glance
| Code | M25.00 |
|---|---|
| Description | Hemarthrosis, unspecified joint |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
What Medicare edits apply to M25.00?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name M25.00 directly.
A code specifying laterality (right, left or bilateral) exists in the same family. CMS holds that there are very limited circumstances in which laterality cannot be documented.
Which MS-DRGs does M25.00 group to?
M25.00 sits in MDC 08 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 553Bone Diseases and Arthropathies with MCCmedical
- 554Bone Diseases and Arthropathies without MCCmedical
As a secondary diagnosis, M25.00 is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.
How is M25.00 listed in the Alphabetic Index?
These are the routes through the Alphabetic Index that lead to M25.00. They show the wording a clinician may have documented, which often differs from the Tabular description.
- Hemarthrosis (nontraumatic)
Excludes1 — never code together — inherited from M25.0
The conditions below can never be reported together with M25.00 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- current injury - see injury of joint by body region
- hemophilic arthropathy (M36.2)
Excludes2 — not included here — inherited from Chapter 13
The conditions below are not part of M25.00, but a patient may have both at the same time. When documentation supports it, M25.00 and the excluded code may both be reported.
- arthropathic psoriasis (L40.5-)
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- compartment syndrome (traumatic) (T79.A-)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
Excludes2 — not included here — inherited from M20-M25
The conditions below are not part of M25.00, but a patient may have both at the same time. When documentation supports it, M25.00 and the excluded code may both be reported.
- joints of the spine (M40-M54)
Excludes2 — not included here — inherited from M25
The conditions below are not part of M25.00, but a patient may have both at the same time. When documentation supports it, M25.00 and the excluded code may both be reported.
How long has M25.00 existed?
M25.00 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.
Which conditions are coded to M25.00?
What other codes are in the M25.0 family? (8)
- M25.01Hemarthrosis, shouldernot billable
- M25.02Hemarthrosis, elbownot billable
- M25.03Hemarthrosis, wristnot billable
- M25.04Hemarthrosis, handnot billable
- M25.05Hemarthrosis, hipnot billable
- M25.06Hemarthrosis, kneenot billable
- M25.07Hemarthrosis, ankle and footnot billable
- M25.08Hemarthrosis, other specified site