M34.81: Systemic sclerosis with lung involvement
M34.81 is a billable, specific ICD-10-CM code for systemic sclerosis with lung involvement. It is valid for submission on a claim.
Check M34.81 with the rest of the claim: free scrubberCode also
Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.
Other codes that can never be billed with M34.81
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
M34.81 risk-adjusts. Under the CMS-HCC V28 model it maps to these categories:
- HCC 93 Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders0.617 RAF
- HCC 278 Idiopathic Pulmonary Fibrosis and Lung Involvement in Systemic Sclerosis0.818 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
M34.81 is named in 17 Medicare coverage policies: 10 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
- Sclerosis, sclerotic›systemic›with›lung involvement
- Disease, diseased›lung›in›systemic›sclerosis
Code history
Unchanged in every release from FY2024 to FY2027.