ICD-10 M12.019
Billable / Specific HCC v28: 40Chronic postrheumatic arthropathy [Jaccoud], unspecified shoulder
About ICD-10-CM M12.019
ICD-10-CM code M12.019 represents Chronic postrheumatic arthropathy [Jaccoud], unspecified shoulder. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M12). The 2026 edition of ICD-10-CM M12.019 became effective on October 1, 2025.
Coding Tips for M12.019
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
M12.019 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 M12.019
Local Coverage Determinations (LCDs) from CMS MACs that list M12.019 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing M12.019.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but M12.019 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with M12.019
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 M12.019 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 |
|---|---|---|
| M12.019 | 7144 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To M12.019
Other codes in section M05-M14 (Inflammatory polyarthropathies).
ICD-10 M12.019, Billing FAQ
Is ICD-10 code M12.019 billable? +
Yes, M12.019 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does M12.019 affect Medicare Advantage HCC risk adjustment? +
Yes. M12.019 maps to CMS-HCC v28 category 40. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does M12.019 map to? +
Per CMS GEMs, M12.019 maps to ICD-9 codes: 7144. 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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