A54.42 ICD-10-CM Code: Gonococcal arthritis
A54.42 maps to CMS-HCC V28 92. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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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)
A54.42
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceGonococcal arthritis
This is a joint infection caused by the bacterium Neisseria gonorrhoeae, which is transmitted through sexual contact. The infection causes inflammation, pain, and swelling in the affected joint or joints.
Buddy Insight
Gonococcal arthritis is the most common musculoskeletal manifestation of disseminated gonococcal infection, typically presenting as acute monoarticular or oligoarticular septic arthritis.
CMS-HCC V28
MappedHCC 92
Coefficient HCC 92: 0.479 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 055
Code-level coefficient reference
ESRD/PACE
MappedHCC 39
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for A54.42. Check the code and parent instructions in the Code Book.
Excludes 2
Official- gonococcal infection of spine (A54.41)
- carrier or suspected carrier of infectious disease (Z22.-)Inherited from A00-B99, A50-A64
- infectious and parasitic diseases complicating pregnancy, childbirth and the puerperium (O98.-)Inherited from A00-B99, A50-A64
- infectious and parasitic diseases specific to the perinatal period (P35-P39)Inherited from A00-B99, A50-A64
- influenza and other acute respiratory infections (J00-J22)Inherited from A00-B99, A50-A64
- human immunodeficiency virus [HIV] disease (B20)Inherited from A00-B99, A50-A64
Related Codes
Includes
Official- diseases generally recognized as communicable or transmissibleInherited from A00-B99
Excludes 1
Official- certain localized infections - see body system-related chaptersInherited from A00-B99, A50-A64
- nonspecific and nongonococcal urethritis (N34.1)Inherited from A00-B99, A50-A64
- Reiter's disease (M02.3-)Inherited from A00-B99, A50-A64
Code First
OfficialNo Code First sequencing instructions are included in this display for A54.42. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify resistance to antimicrobial drugs (Z16.-)Inherited from A00-B99
Code Also
OfficialNo Code Also instructions are included in this display for A54.42. Check the code and parent instructions in the Code Book.
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 A54.42 an HCC code?
Yes. A54.42 (Gonococcal arthritis) maps to HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.479. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: A54.42 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
- A54.42
- Description
- Gonococcal arthritis
- HCC (V28)
- HCC 92 — Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
- RAF reference coefficient
- 0.479
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work A54.42 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for A54.42
For A54.42, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
A54.42 is the ICD-10-CM diagnosis code for gonococcal arthritis. This is a joint infection caused by the bacterium Neisseria gonorrhoeae, which is transmitted through sexual contact. The infection causes inflammation, pain, and swelling in the affected joint or joints. A54.42 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, A54.42 maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis (HCC 92) with a source-labeled community, non-dual, aged reference coefficient of 0.479. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Verify documentation specifies gonococcal arthritis rather than other types of arthritis; the causative organism must be identified as gonorrhea. For A54.42, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for A54.42 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies gonococcal arthritis rather than other types of arthritis; the causative organism must be identified as gonorrhea
- •Determine if the condition is acute or chronic, and identify the specific joint(s) affected, as additional codes may be needed for laterality and site specificity
Clinical Significance
Gonococcal arthritis is the most common musculoskeletal manifestation of disseminated gonococcal infection, typically presenting as acute monoarticular or oligoarticular septic arthritis. It requires urgent joint aspiration and IV antibiotics to prevent permanent joint destruction and reflects significant acute illness complexity.
Documentation Requirements
- ✓Positive Neisseria gonorrhoeae culture from synovial fluid or blood, or positive NAAT
- ✓Specific joint(s) affected with laterality documented
- ✓Synovial fluid analysis results (WBC count, Gram stain, culture)
- ✓Clinical presentation: acute onset, joint swelling, erythema, limited range of motion
- ✓Documentation of whether the infection is acute or chronic, and treatment response
Excludes 2, Not included here, may code separately
- gonococcal infection of spine (A54.41)
Commonly Confused Codes
- •M00.9 (Pyogenic arthritis, unspecified): General septic arthritis from any bacterial cause; use A54.42 only when gonococcal etiology is confirmed
- •M02.30 (Reiter disease, unspecified site): Reactive arthritis can follow STIs but is immune-mediated, not a direct joint infection; gonococcal arthritis has organisms present in the joint
- •A54.40 (Gonococcal infection of musculoskeletal system, unspecified): Use A54.42 when joint involvement is specifically documented