Is M06.4 a billable ICD-10-CM code?

Yes. M06.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does M06.4 sit in the tabular list?

Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Inflammatory polyarthropathies (M05-M14).

What cannot be coded together with M06.4?

M06.4 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

M06.4

M06.4 — Inflammatory polyarthropathy

Billable / specific codeICD-10-CM

M06.4 is a billable, specific ICD-10-CM code for inflammatory polyarthropathy. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

polyarthritis NOS (M13.0)

Risk adjustment

M06.4 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.

Medicare coverage

M06.4 is named in 19 Medicare coverage policies — 13 listing it as supporting medical necessity, and 6 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A58865Billing 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
A59434Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Woundnot covered

How M06.4 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 M06.4.

Polyarthritis, polyarthropathy›inflammatory

Related codes at this level

Codes that share M06. If M06.4 is not quite right, the correct code is usually one of these.

Questions about M06.4

Is M06.4 a billable ICD-10-CM code?: Yes. M06.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does M06.4 sit in the tabular list?: Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Inflammatory polyarthropathies (M05-M14).
What cannot be coded together with M06.4?: M06.4 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.