ICD-10 M00.862
Billable / Specific HCC v28: 39 CCArthritis due to other bacteria, left knee
About ICD-10-CM M00.862
ICD-10-CM code M00.862 represents Arthritis due to other bacteria, left knee. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M00). The 2026 edition of ICD-10-CM M00.862 became effective on October 1, 2025.
Coding Tips for M00.862
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
M00.862 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.
M00.862 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 other bacteria, left knee. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for M00.862
Local Coverage Determinations (LCDs) from CMS MACs that list M00.862 as a covered diagnosis.
Showing top 10 of 688 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing M00.862.
5 Medicare
CPT Codes Commonly Billed with M00.862
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 29871 CMS LCD: Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for Osteoarthritic Knees CMS LCD
Convert M00.862 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 |
|---|---|---|
| M00.862 | 04189 | 10112 |
| M00.862 | 71106 | 10111 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To M00.862
Other codes in section M00-M02 (Infectious arthropathies).
ICD-10 M00.862, Billing FAQ
Is ICD-10 code M00.862 billable? +
Yes, M00.862 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does M00.862 affect Medicare Advantage HCC risk adjustment? +
Yes. M00.862 maps to CMS-HCC v28 category 39. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is M00.862 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 M00.862? +
Procedures frequently paired with M00.862 include: 29871.
What ICD-9 codes does M00.862 map to? +
Per CMS GEMs, M00.862 maps to ICD-9 codes: 04189, 71106. 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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