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.
Excludes2 — 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
These codes carry an Excludes1 note pointing at A54.42. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading A54.42 alone.
- 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.
Medicare coverage
A54.42 is named in 5 Medicare coverage policies — 5 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- 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
How A54.42 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to A54.42.
- Arthritis, arthritic›blennorrhagic(gonococcal)
- Arthritis, arthritic›gonococcal
- Gonococcus, gonococcal›joint
- Hydrarthrosis›gonococcal
- Periarthritis›gonococcal
- Gonococcus, gonococcal›musculoskeletal›arthritis
Related codes at this level
Codes that share A54.4. If A54.42 is not quite right, the correct code is usually one of these.
Questions about A54.42
- Is A54.42 a billable ICD-10-CM code?
- Yes. A54.42 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does A54.42 sit in the tabular list?
- Certain infectious and parasitic diseases (A00-B99), in the block Infections with a predominantly sexual mode of transmission (A50-A64).