ICD-10 M08.469
Billable / Specific HCC v28: 40Pauciarticular juvenile rheumatoid arthritis, unspecified knee
About ICD-10-CM M08.469
ICD-10-CM code M08.469 represents Pauciarticular juvenile rheumatoid arthritis, unspecified knee. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M08). The 2026 edition of ICD-10-CM M08.469 became effective on October 1, 2025.
Coding Tips for M08.469
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
M08.469 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
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 M08.469
Local Coverage Determinations (LCDs) from CMS MACs that list M08.469 as a covered diagnosis.
Showing top 8. Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing M08.469.
1 Medicare
CPT Codes Commonly Billed with M08.469
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
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 M08.469 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 |
|---|---|---|
| M08.469 | 71432 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To M08.469
Other codes in section M05-M14 (Inflammatory polyarthropathies).
ICD-10 M08.469, Billing FAQ
Is ICD-10 code M08.469 billable? +
Yes, M08.469 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does M08.469 affect Medicare Advantage HCC risk adjustment? +
Yes. M08.469 maps to CMS-HCC v28 category 40. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does M08.469 map to? +
Per CMS GEMs, M08.469 maps to ICD-9 codes: 71432. 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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