A54.42: Gonococcal arthritis
A54.42 is a billable, specific ICD-10-CM code for gonococcal arthritis. It is valid for submission on a claim.
Check A54.42 with the rest of the claim: free scrubberExcludes2: not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
- gonococcal infection of spine (A54.41)
Other codes that can never be billed with A54.42
Their own Excludes1 notes name this code, so the conflict is not listed above.
- M01Direct infections of joint in infectious and parasitic diseases classified elsewhere
Risk adjustment
A54.42 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 92 Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis0.479 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
A54.42 is named in 5 Medicare coverage policies: 5 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A54061Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for Osteoarthritic Knees
- A58710Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
- A58720Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
- A58747Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
Alphabetic index entries that lead here
- Arthritis, arthritic›blennorrhagic(gonococcal)
- Arthritis, arthritic›gonococcal
- Gonococcus, gonococcal›joint
- Hydrarthrosis›gonococcal
- Periarthritis›gonococcal
- Gonococcus, gonococcal›musculoskeletal›arthritis
Code history
Unchanged in every release from FY2024 to FY2027.