M04 — Autoinflammatory syndromes
ICD-10-CM codes M04 cover autoinflammatory syndromes, within diseases of the musculoskeletal system and connective tissue. The block holds 5 codes across 1 category, of which 4 are billable and 1 are header codes that cannot be submitted on a claim.
Risk adjustment in M04
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 94 Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders
What else to watch in M04
- 4 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.