A54.40 ICD-10-CM Code: Gonococcal infection of musculoskeletal system, unspecified
HCC Buddy Code Card
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FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Infections with a predominantly sexual mode of transmission (A50-A64)
A54.40
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceGonococcal infection of musculoskeletal system, unspecified
This code describes a bacterial infection caused by gonorrhea that affects the muscles, bones, joints, or connective tissues, but the specific location is not documented. Gonorrhea is a sexually transmitted infection that can spread beyond the genital area to cause inflammation and infection in the musculoskeletal system.
Buddy Insight
Gonococcal infection of the musculoskeletal system represents disseminated gonococcal infection, a serious systemic complication of untreated gonorrhea requiring aggressive antibiotic therapy.
CMS-HCC V28
MappedHCC 92
RAF 0.479
CMS-HCC V24
MappedHCC 39
RAF 0.401
ACA/HHS
MappedHCC 55
Varies by metal level
ESRD/PACE
MappedHCC 39
RAF 0.092
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for A54.40 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for A54.40 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for A54.40 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for A54.40 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for A54.40 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for A54.40 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for A54.40 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is A54.40 an HCC code?
Yes. A54.40 (Gonococcal infection of musculoskeletal system, unspecified) maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis under the CMS-HCC V28 risk adjustment model (and Bone/Joint/Muscle Infections/Necrosis under V24), with a community non-dual aged RAF of 0.479. It is billable for payment year 2026.
Coder answer: A54.40 is billable and maps to V28 HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- A54.40
- Description
- Gonococcal infection of musculoskeletal system, unspecified
- HCC (V28)
- HCC 92 — Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
- RAF
- 0.479
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
Work A54.40 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for A54.40
For A54.40 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed A54.40 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
A54.40 is the ICD-10-CM diagnosis code for gonococcal infection of musculoskeletal system, unspecified. This code describes a bacterial infection caused by gonorrhea that affects the muscles, bones, joints, or connective tissues, but the specific location is not documented. Gonorrhea is a sexually transmitted infection that can spread beyond the genital area to cause inflammation and infection in the musculoskeletal system. A54.40 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering infections with a predominantly sexual mode of transmission (a50-a64).
Under the CMS-HCC V28 risk adjustment model, A54.40 maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis (HCC 92) with a community, non-dual, aged base RAF weight of 0.479. Under the older CMS-HCC V24 model, A54.40 maps to Bone/Joint/Muscle Infections/Necrosis (HCC 39) with a community, non-dual, aged base RAF weight of 0.401. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
If the specific site of musculoskeletal involvement is documented (such as knee, shoulder, or spine), use a more specific code from the A54.4- subcategory rather than the unspecified code. Because A54.40 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for A54.40 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •If the specific site of musculoskeletal involvement is documented (such as knee, shoulder, or spine), use a more specific code from the A54.4- subcategory rather than the unspecified code
- •Verify documentation confirms gonococcal etiology and musculoskeletal involvement; query the provider if the infection site or organism is unclear
Clinical Significance
Gonococcal infection of the musculoskeletal system represents disseminated gonococcal infection, a serious systemic complication of untreated gonorrhea requiring aggressive antibiotic therapy. This unspecified code should prompt a query for more specific site documentation to ensure accurate coding and appropriate risk capture.
Documentation Requirements
- ✓Confirmation of Neisseria gonorrhoeae as the causative organism (culture or NAAT testing)
- ✓Musculoskeletal site involvement documented (even if unspecified, note the clinical presentation)
- ✓Evidence of disseminated gonococcal infection (DGI) versus localized infection
- ✓Treatment regimen documented (typically IV ceftriaxone)
- ✓Response to treatment and any complications
Commonly Confused Codes
- •A54.42 (Gonococcal arthritis): If the specific musculoskeletal site is a joint, use A54.42 instead of the unspecified code
- •A54.43 (Gonococcal osteomyelitis): If bone involvement is documented, use the osteomyelitis-specific code
- •M00.9 (Pyogenic arthritis, unspecified): General septic arthritis without gonococcal etiology confirmation; gonococcal arthritis requires identification of Neisseria gonorrhoeae