M35.81: Multisystem inflammatory syndrome
M35.81 is a billable, specific ICD-10-CM code for multisystem inflammatory syndrome. It is valid for submission on a claim.
Check M35.81 with the rest of the claim: free scrubberCode first
The underlying condition must be sequenced before this code.
- , if applicable, COVID-19 (U07.1)
Use additional code
Add a secondary code to capture the detail described below.
Code also
Both codes may be needed to describe the encounter fully. Sequencing depends on the reason for the visit.
- any associated complications such as:
- acute hepatic failure (K72.0-)
- acute kidney failure (N17.-)
- acute myocarditis (I40.-)
- acute respiratory distress syndrome (J80)
- cardiac arrhythmia (I47-I49.-)
- pneumonia due to COVID-19 (J12.82)
- severe sepsis (R65.2-)
- viral cardiomyopathy (B33.24)
- viral pericarditis (B33.23)
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- MIS-A
- MIS-C
- Multisystem inflammatory syndrome in adults
- Multisystem inflammatory syndrome in children
- Pediatric inflammatory multisystem syndrome
- PIMS
Risk adjustment
M35.81 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 2 Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock0.500 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
M35.81 is named in 15 Medicare coverage policies: 8 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
- MIS-A
- MIS-C
- Multisystem inflammatory syndrome(in adult) (in children)
- Pediatric inflammatory multisystem syndrome
- PIMS
- Syndrome›multisystem inflammatory(in adults) (in children)
- Syndrome›pediatric inflammatory multisystem
Code history
Unchanged in every release from FY2024 to FY2027.