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

ICD-10 M32.0

Billable / Specific HCC v28: 40

Drug-induced systemic lupus erythematosus

M32
Block
0
Synonyms
366
LCDs
32
Payer Policies
0
Linked CPTs

About ICD-10-CM M32.0

ICD-10-CM code M32.0 represents Drug-induced systemic lupus erythematosus. This is a billable/specific code in the Musculoskeletal and Connective Tissue chapter (block M32). The 2026 edition of ICD-10-CM M32.0 became effective on October 1, 2025.

Coding Tips for M32.0

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

HCC capture: document with MEAT each year

M32.0 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.

Use Additional Code

When coding M32.0, also report these additional codes when applicable.

  • code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

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 M32.0

Local Coverage Determinations (LCDs) from CMS MACs that list M32.0 as a covered diagnosis.

366 LCDs

Showing top 10 of 366 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Article ID: 53060, Effective: 2025-10-01 00:00:00, 1692 covered, 0 non-covered
CPT 92201 →
CMS LCD: Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Article ID: 53060, Effective: 2025-10-01 00:00:00, 1692 covered, 0 non-covered
CPT 92250 →
CMS LCD: Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Article ID: 53060, Effective: 2025-10-01 00:00:00, 1692 covered, 0 non-covered
CPT 92202 →
CMS LCD: Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Article ID: 53060, Effective: 2025-10-01 00:00:00, 1692 covered, 0 non-covered
CPT 92227 →
CMS LCD: Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Article ID: 53060, Effective: 2025-10-01 00:00:00, 1692 covered, 0 non-covered
CPT 92228 →
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: Vitamin D; 25 hydroxy, includes fraction(s), if performed
Article ID: 56841, Effective: 2023-10-01 00:00:00, 759 covered, 1 non-covered
CPT 82306 →
CMS LCD: Billing and Coding: Assays for Vitamins and Metabolic Function
Article ID: 56416, Effective: 2025-10-01 00:00:00, 899 covered, 1 non-covered
CPT 82306 →
CMS LCD: Billing and Coding: Assays for Vitamins and Metabolic Function
Article ID: 56416, Effective: 2025-10-01 00:00:00, 899 covered, 1 non-covered
CPT 82607 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing M32.0.

32 policies

2 Cigna

Transthoracic Echocardiography in Children - (0523)
Policy ID: MM_0523
Vitamin D Testing - (0526) ---- future effective policy
Policy ID: MM_0526

5 Medicare

Billing and Coding: Cardiac Catheterization and Coronary Angiography
Policy ID: ART-52850
Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
Policy ID: ART-53060
Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions
Policy ID: ART-55639
Billing and Coding: Assays for Vitamins and Metabolic Function
Policy ID: ART-56416
Billing and Coding: Erythropoiesis Stimulating Agents (ESA)
Policy ID: ART-56462

CPT Codes Commonly Billed with M32.0

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

No procedure linkages on file for M32.0

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 M32.0 to ICD-9-CM

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

ICD-10ICD-9Mapping Flags
M32.0 7100 10000

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

ICD-10 M32.0, Billing FAQ

Is ICD-10 code M32.0 billable? +

Yes, M32.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

Does M32.0 affect Medicare Advantage HCC risk adjustment? +

Yes. M32.0 maps to CMS-HCC v28 category 40. Capture this diagnosis annually for accurate Medicare Advantage risk score.

What ICD-9 codes does M32.0 map to? +

Per CMS GEMs, M32.0 maps to ICD-9 codes: 7100. 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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