M04.8
M04.8: Other autoinflammatory syndromes
Billable / specific codeICD-10-CM
M04.8 is a billable, specific ICD-10-CM code for other autoinflammatory syndromes. It is valid for submission on a claim.
Check M04.8 with the rest of the claim: free scrubberInclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Blau syndrome
- Deficiency of interleukin 1 receptor antagonist [DIRA]
- Majeed syndrome
- Periodic fever, aphthous stomatitis, pharyngitis, and adenopathy syndrome [PFAPA]
- Pyogenic arthritis, pyoderma gangrenosum, and acne syndrome [PAPA]
Risk adjustment
M04.8 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 94 Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders0.268 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
M04.8 is named in 7 Medicare coverage policies: 0 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
- DIRA(deficiency of interleukin 1 receptor antagonist)
- PAPA(pyogenic arthritis, pyoderma gangrenosum, and acne syndrome)
- PFAPA(periodic fever, aphthous stomatitis, pharyngitis, and adenopathy syndrome)
- Deficiency, deficient›of interleukin 1 receptor antagonist [DIRA]
- Syndrome›Blau
- Syndrome›Majeed
- Syndrome›periodic fever, aphthous stomatitis, pharyngitis, and adenopathy [PFAPA]
- Syndrome›pyogenic arthritis, pyoderma gangrenosum, and acne [PAPA]
- Syndrome›Yao
- Disease, diseased›autoinflammatory›NOD2-associated
- Disease, diseased›autoinflammatory›specified type NEC
- Syndrome›autoinflammatory›specified type NEC
Code history
Unchanged in every release from FY2024 to FY2027.