M00.822
BillableArthritis due to other bacteria, left elbow
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M00.822 an HCC code?
Yes. M00.822 maps to Bone/Joint/Muscle Infections/Necrosis under the CMS-HCC V28 risk adjustment model (and Bone/Joint/Muscle Infections/Necrosis under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for M00.822
For M00.822to 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 M00.822 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M00.822 is the ICD-10-CM diagnosis code for arthritis due to other bacteria, left elbow. Infection and inflammation of the left elbow joint caused by bacteria other than the common ones typically associated with arthritis. M00.822 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, M00.822 maps to Bone/Joint/Muscle Infections/Necrosis (HCC 92) with a community, non-dual, aged base RAF weight of 0.209. Under the older V24 model, M00.822 mapped to the same category but with a base RAF weight of 0.482 — V28 recalibrated weights across the entire model. 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.
Confirm the left elbow is specifically documented as the affected site. Because M00.822 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 M00.822 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm the left elbow is specifically documented as the affected site
- •Review culture results or clinical documentation to verify the causative organism classification
Clinical Significance
Bacterial arthritis of the left elbow represents a serious infectious process that can result in joint destruction and permanent functional impairment. Early recognition and aggressive treatment are critical to preserve joint function and prevent systemic complications.
Documentation Requirements
- ✓Documentation of 'other bacteria' as causative agent (excluding common pathogens)
- ✓Clear identification of left elbow joint involvement
- ✓Microbiological evidence of bacterial infection
- ✓Clinical presentation consistent with infectious arthritis
- ✓Evidence of antimicrobial therapy initiation
- ✓Assessment of joint function and range of motion
- ✓Laboratory markers of inflammation and infection
- ✓Differentiation from non-infectious elbow conditions
Commonly Confused Codes
- •M00022 — Streptococcal arthritis of left elbow (specific organism)
- •M00012 — Staphylococcal arthritis of left elbow (different bacteria)
- •M06.822 — Other specified rheumatoid arthritis of left elbow (autoimmune)
- •M19.022 — Primary osteoarthritis of left elbow (wear and tear)
- •M70.22 — Olecranon bursitis of left elbow (bursa inflammation, not joint)