M00.162 ICD-10-CM Code: Pneumococcal arthritis, left knee
M00.162 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
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Infectious arthropathies (M00-M02)
M00.162
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePneumococcal arthritis, left knee
A bacterial infection of the left knee joint caused by pneumococcus bacteria, resulting in joint inflammation and pain.
Buddy Insight
Septic arthritis of the left knee caused by Streptococcus pneumoniae (pneumococcal) organisms is a serious infectious condition requiring emergent treatment with intravenous antibiotics and often surgical intervention.
CMS-HCC V28
MappedHCC 92
Code-level coefficient reference
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 M00.162. Check the code and parent instructions in the Code Book.
Excludes 2
Official- arthropathic psoriasis (L40.5-)Inherited from M00-M99, M00
- certain conditions originating in the perinatal period (P04-P96)Inherited from M00-M99, M00
- certain infectious and parasitic diseases (A00-B99)Inherited from M00-M99, M00
- compartment syndrome (traumatic) (T79.A-)Inherited from M00-M99, M00
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from M00-M99, M00
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from M00-M99, M00
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from M00-M99, M00
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from M00-M99, M00
- neoplasms (C00-D49)Inherited from M00-M99, M00
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from M00-M99, M00
- infection and inflammatory reaction due to internal joint prosthesis (T84.5-)Inherited from M00-M99, M00
Related Codes
Includes
OfficialNo Includes notes are included in this display for M00.162. Check the code and parent instructions in the Code Book.
Excludes 1
OfficialNo Excludes 1 notes are included in this display for M00.162. Check the code and parent instructions in the Code Book.
Code First
OfficialNo Code First sequencing instructions are included in this display for M00.162. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for M00.162. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for M00.162. 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 M00.162 an HCC code?
Yes. M00.162 (Pneumococcal arthritis, left knee) 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: M00.162 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
- M00.162
- Description
- Pneumococcal arthritis, left knee
- 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 M00.162 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for M00.162
For M00.162, 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
Get the V28 mapping + MEAT cheat sheet
One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.
Free PDF. No card. Unsubscribe anytime.
What This Code Means
M00.162 is the ICD-10-CM diagnosis code for pneumococcal arthritis, left knee. A bacterial infection of the left knee joint caused by pneumococcus bacteria, resulting in joint inflammation and pain. M00.162 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering infectious arthropathies (m00-m02).
Under the CMS-HCC V28 risk adjustment model, M00.162 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. No V24 mapping is shown for M00.162; use the applicable model and payment year when reviewing the V28 mapping. 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.
Ensure left knee is specifically documented to avoid confusion with right knee. For M00.162, 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 M00.162 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure left knee is specifically documented to avoid confusion with right knee
- •Confirm diagnostic methods used (culture, imaging) to support the pneumococcal diagnosis
Clinical Significance
Septic arthritis of the left knee caused by Streptococcus pneumoniae (pneumococcal) organisms is a serious infectious condition requiring emergent treatment with intravenous antibiotics and often surgical intervention. Involvement of the left knee, a large weight-bearing or major joint, increases the risk of significant functional impairment and may require arthroscopic or open surgical drainage. This condition reflects high healthcare complexity and resource needs, making it significant for risk adjustment.
Documentation Requirements
- ✓Provider documentation explicitly stating pneumococcal septic arthritis or pyogenic arthritis with identified causative organism
- ✓Synovial fluid analysis results (cell count, Gram stain, crystal analysis to rule out gout/pseudogout)
- ✓Culture and sensitivity results identifying the specific pneumococcal organism, or clinical rationale if culture-negative
- ✓Clinical signs and symptoms of joint infection (acute onset joint pain, swelling, warmth, erythema, fever, limited range of motion)
- ✓Documentation confirming left-sided involvement with imaging or examination findings specific to that side
- ✓Treatment plan including antibiotic regimen, duration, and any surgical intervention (arthrocentesis, irrigation and debridement, arthroscopy)
Commonly Confused Codes
- •M00.2x (Other streptococcal arthritis): Use M00.2x when the causative streptococcal organism is not Streptococcus pneumoniae; M00.1x is specifically for pneumococcal (Streptococcus pneumoniae) joint infections
- •M00.8x (Arthritis due to other bacteria): Use M00.8x when the septic arthritis is caused by a non-streptococcal bacterium such as Staphylococcus aureus, Pseudomonas, or gram-negative rods
- •M00.0x (Staphylococcal arthritis): Use M00.0x when culture identifies Staphylococcus species rather than Streptococcus pneumoniae