ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 M05.679

Billable / Specific HCC v28: 40

Rheumatoid arthritis of unspecified ankle and foot with involvement of other organs and systems

M05
Block
0
Synonyms
70
LCDs
7
Payer Policies
0
Linked CPTs

About ICD-10-CM M05.679

ICD-10-CM code M05.679 represents Rheumatoid arthritis of unspecified ankle and foot with involvement of other organs and systems. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M05). The 2026 edition of ICD-10-CM M05.679 became effective on October 1, 2025.

Coding Tips for M05.679

Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.

HCC capture: document with MEAT each year

M05.679 is a CMS-HCC v28 risk-adjustment code (category 40). 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.

Medicare Advantage HCC Impact

CMS-HCC v28 (current)
Category 40
ESRD-HCC
Category 40
RxHCC (Part D)
Category 40

Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.

Medicare LCD Coverage for M05.679

Local Coverage Determinations (LCDs) from CMS MACs that list M05.679 as a covered diagnosis.

70 LCDs

Showing top 10 of 70 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Sedimentation Rate, Erythrocyte
Article ID: 57657, Effective: 2024-10-01 00:00:00, 1430 covered, 1 non-covered
CPT 85651 →
CMS LCD: Billing and Coding: Sedimentation Rate, Erythrocyte
Article ID: 57657, Effective: 2024-10-01 00:00:00, 1430 covered, 1 non-covered
CPT 85652 →
CMS LCD: Billing and Coding: Infliximab
Article ID: 56432, Effective: 2026-01-01 00:00:00, 406 covered, 0 non-covered
CPT J1745 →
CMS LCD: Billing and Coding: Infliximab
Article ID: 56432, Effective: 2026-01-01 00:00:00, 406 covered, 0 non-covered
CPT Q5103 →
CMS LCD: Billing and Coding: Infliximab
Article ID: 56432, Effective: 2026-01-01 00:00:00, 406 covered, 0 non-covered
CPT Q5121 →
CMS LCD: Billing and Coding: Infliximab
Article ID: 56432, Effective: 2026-01-01 00:00:00, 406 covered, 0 non-covered
CPT Q5104 →
CMS LCD: Billing and Coding: Biomarkers Overview
Article ID: 56541, Effective: 2024-01-01 00:00:00, 403 covered, 0 non-covered
CPT 81376 →
CMS LCD: Billing and Coding: Biomarkers Overview
Article ID: 56541, Effective: 2024-01-01 00:00:00, 403 covered, 0 non-covered
CPT 81250 →
CMS LCD: Billing and Coding: Biomarkers Overview
Article ID: 56541, Effective: 2024-01-01 00:00:00, 403 covered, 0 non-covered
CPT 81300 →
CMS LCD: Billing and Coding: Biomarkers Overview
Article ID: 56541, Effective: 2024-01-01 00:00:00, 403 covered, 0 non-covered
CPT 81201 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing M05.679.

7 policies

1 Cigna

Peripheral Nerve Destruction for Pain Conditions - (0525) ---- future effective policy
Policy ID: MM_0525

5 Medicare

Billing and Coding: Infliximab and biosimilars
Policy ID: ART-52423
Billing and Coding: Infliximab
Policy ID: ART-56432
Billing and Coding: Biomarkers Overview
Policy ID: ART-56541
Billing and Coding: Sedimentation Rate, Erythrocyte
Policy ID: ART-57657
Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars
Policy ID: ART-59101

CPT Codes Commonly Billed with M05.679

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

No procedure linkages on file for M05.679

We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.

Convert M05.679 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
M05.679 7142 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 M05.679, Billing FAQ

Is ICD-10 code M05.679 billable? +

Yes, M05.679 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

Does M05.679 affect Medicare Advantage HCC risk adjustment? +

Yes. M05.679 maps to CMS-HCC v28 category 40. Capture this diagnosis annually for accurate Medicare Advantage risk score.

What ICD-9 codes does M05.679 map to? +

Per CMS GEMs, M05.679 maps to ICD-9 codes: 7142. 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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