M42.05 — Juvenile osteochondrosis of spine, thoracolumbar region
M42.05 is a billable, specific ICD-10-CM code for juvenile osteochondrosis of spine, thoracolumbar region. It is valid for submission on a claim.
Risk adjustment
M42.05 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
M42.05 is named in 9 Medicare coverage policies — 3 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 M42.05 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 M42.05.
- Osteochondrosis›juvenile, juvenilis›spine›thoracolumbar region
Related codes at this level
Codes that share M42.0. If M42.05 is not quite right, the correct code is usually one of these.
- M42.00Juvenile osteochondrosis of spine, site unspecified
- M42.01Juvenile osteochondrosis of spine, occipito-atlanto-axial region
- M42.02Juvenile osteochondrosis of spine, cervical region
- M42.03Juvenile osteochondrosis of spine, cervicothoracic region
- M42.04Juvenile osteochondrosis of spine, thoracic region
- M42.06Juvenile osteochondrosis of spine, lumbar region
- M42.07Juvenile osteochondrosis of spine, lumbosacral region
- M42.08Juvenile osteochondrosis of spine, sacral and sacrococcygeal region
- M42.09Juvenile osteochondrosis of spine, multiple sites in spine
Questions about M42.05
- Is M42.05 a billable ICD-10-CM code?
- Yes. M42.05 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does M42.05 sit in the tabular list?
- Diseases of the musculoskeletal system and connective tissue (M00-M99), in the block Deforming dorsopathies (M40-M43).