M00-M25 — Arthropathies
ICD-10-CM codes M00-M25 cover arthropathies, within diseases of the musculoskeletal system and connective tissue. The block holds 3,091 codes across 5 sub-blocks, of which 2,248 are billable and 843 are header codes that cannot be submitted on a claim. 404 of them (13%) require a 7th character.
Includes
Conditions this code covers.
- Disorders affecting predominantly peripheral (limb) joints
The 7th character in M00-M25
A code in this block is not complete without its 7th character, and a missing one is a rejected claim rather than a denied one: the clearinghouse never passes it on. 404 of the 3,091 codes here take one.
- 0
- without tophus (tophi)
- 1
- with tophus (tophi)
Risk adjustment in M00-M25
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 93 Rheumatoid Arthritis and Other Specified Inflammatory Rheumatic Disorders
- HCC 92 Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
- HCC 94 Systemic Lupus Erythematosus and Other Specified Systemic Connective Tissue Disorders
What else to watch in M00-M25
- 1,394 codes are laterality-specific. They come in left and right pairs, and the pair is mutually exclusive on a single site: coding both without a bilateral code is a contradiction a scrubber should catch before the payer does.
- 2,248 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.