M00-M02 — Infectious arthropathies
ICD-10-CM codes M00-M02 cover infectious arthropathies, within diseases of the musculoskeletal system and connective tissue. The block holds 325 codes across 3 categories, of which 242 are billable and 83 are header codes that cannot be submitted on a claim.
Notes
Additional guidance from the ICD-10-CM tabular list.
- This block comprises arthropathies due to microbiological agents. Distinction is made between the following types of etiological relationship:
- a) direct infection of joint, where organisms invade synovial tissue and microbial antigen is present in the joint;
- b) indirect infection, which may be of two types: a reactive arthropathy, where microbial infection of the body is established but neither organisms nor antigens can be identified in the joint, and a postinfective arthropathy, where microbial antigen is present but recovery of an organism is inconstant and evidence of local multiplication is lacking.
Risk adjustment in M00-M02
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 92 Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
- HCC 94 Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders
What else to watch in M00-M02
- 140 codes are laterality-specific. They come in left and right pairs, and the pair is mutually exclusive on a single site: coding both without a bilateral code is a contradiction a scrubber should catch before the payer does.
- 242 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.