Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0 (FY2026), Appendix B.

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

HCC 93 — Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders (supersedes HCC 94)

Other models: CMS-HCC V22 HCC 40 · RxHCC V08 HCC 83

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Code Set: Valid FY2026 and FY2027. FY2026 took effect October 1, 2025.

Rheumatoid myopathy with rheumatoid arthritis of unspecified hip is a billable ICD-10-CM diagnosis code (M05.459).

Sequencing, inclusion, and exclusion notes published for M05.459 in the official ICD-10-CM tabular list.

Conditions that can never be reported with this code; the two are mutually exclusive.

Official ICD-10-CM classifications closest to M05.459 in its code family, with their registry titles.