ICD-10 A69.23
Billable / Specific HCC v28: 39 CCArthritis due to Lyme disease
About ICD-10-CM A69.23
ICD-10-CM code A69.23 represents Arthritis due to Lyme disease. This is a billable/specific code in the Infectious and Parasitic Diseases chapter (block A69). The 2026 edition of ICD-10-CM A69.23 became effective on October 1, 2025.
Coding Tips for A69.23
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
A69.23 is a CMS-HCC v28 risk-adjustment code (category 39). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
A69.23 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Arthritis due to Lyme disease. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for A69.23
Local Coverage Determinations (LCDs) from CMS MACs that list A69.23 as a covered diagnosis.
Showing top 10 of 74 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing A69.23.
3 Medicare
CPT Codes Commonly Billed with A69.23
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- Q9957 CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE) CMS LCD
- Q9955 CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE) CMS LCD
- C8923 CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE) CMS LCD
- C8928 CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE) CMS LCD
- C8924 CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE) CMS LCD
- C8921 CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE) CMS LCD
- 76376 CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE) CMS LCD
- C8930 CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE) CMS LCD
- C8929 CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE) CMS LCD
- C8922 CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE) CMS LCD
Convert A69.23 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| A69.23 | 08881 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To A69.23
Other codes in section A65-A69 (Other spirochetal diseases).
ICD-10 A69.23, Billing FAQ
Is ICD-10 code A69.23 billable? +
Yes, A69.23 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does A69.23 affect Medicare Advantage HCC risk adjustment? +
Yes. A69.23 maps to CMS-HCC v28 category 39. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is A69.23 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with A69.23? +
Procedures frequently paired with A69.23 include: Q9957, Q9955, C8923, C8928, C8924.
What ICD-9 codes does A69.23 map to? +
Per CMS GEMs, A69.23 maps to ICD-9 codes: 08881. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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