M04.3

M04.3: VEXAS syndrome

Billable / specific codeICD-10-CM

M04.3 is a billable, specific ICD-10-CM code for vexas syndrome. It is valid for submission on a claim.

Check M04.3 with the rest of the claim: free scrubber

Code also

Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.

any associated conditions

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Vacuoles, E1 ubiquitin-activating enzyme, X-linked, autoinflammatory, somatic syndrome

Excludes2 inherited from the categories above M04.3

Not part of this code, but both may be coded when both are present.

Written on M04: Autoinflammatory syndromes

Crohn's disease (K50.-)

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

M04.3 is named in 12 Medicare coverage policies: 5 listing it as supporting medical necessity, and 7 listing it as NOT covered. Which one applies depends on your Medicare contractor.

A58865Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A58883Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A58893Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered
A59374Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered

Alphabetic index entries that lead here

Syndrome›vacuoles, E1 ubiquitin-activating enzyme, X-linked, autoinflammatory, somatic(VEXAS)
Syndrome›VEXAS(vacuoles, E1 ubiquitin-activating enzyme, X-linked, autoinflammatory, somatic)

Code history

addedFY2024-FY2027
VEXAS syndrome