M00.88 ICD-10-CM Code: Arthritis due to other bacteria, vertebrae
M00.88 maps to CMS-HCC V28 92. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC coding software
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)
M00.88
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceArthritis due to other bacteria, vertebrae
Bacterial infection causing inflammation and swelling in the vertebrae (spine bones), caused by bacteria other than the most common types.
Buddy Insight
Bacterial arthritis of the vertebrae (spondylitis) represents one of the most serious forms of infectious arthropathy due to proximity to the spinal cord and risk of neurological complications.
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
OfficialICD-10-CM does not list inclusion terms for M00.88 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M00.88 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M00.88 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for M00.88 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M00.88 in this effective period.
Use Additional
Official- code (B96) to identify bacteria
Code Also
OfficialICD-10-CM does not list Code Also instructions for M00.88 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 M00.88 an HCC code?
Yes. M00.88 (Arthritis due to other bacteria, vertebrae) 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: M00.88 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
- M00.88
- Description
- Arthritis due to other bacteria, vertebrae
- 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 M00.88 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT Criteria for M00.88
For M00.88 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 M00.88 during that encounter, not just copy-forwarded from a problem list.
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
M00.88 is the ICD-10-CM diagnosis code for arthritis due to other bacteria, vertebrae. Bacterial infection causing inflammation and swelling in the vertebrae (spine bones), caused by bacteria other than the most common types. M00.88 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, M00.88 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 M00.88; use the applicable model and payment year when reviewing the V28 mapping. 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. 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.
This code does not require laterality specification as vertebrae are midline structures. Because M00.88 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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 M00.88 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code does not require laterality specification as vertebrae are midline structures
- •Verify the bacterial organism is documented; if not specified, consider if a more general code applies
Clinical Significance
Bacterial arthritis of the vertebrae (spondylitis) represents one of the most serious forms of infectious arthropathy due to proximity to the spinal cord and risk of neurological complications. This condition requires immediate treatment to prevent spinal instability, abscess formation, and permanent neurological damage.
Documentation Requirements
- ✓Confirmation of 'other bacteria' as causative organism
- ✓Documentation of vertebral joint involvement
- ✓Microbiological evidence of bacterial infection
- ✓Clinical signs of spinal infection
- ✓Evidence of systemic antibiotic therapy
- ✓Neurological assessment and monitoring
- ✓Imaging studies showing vertebral involvement
- ✓Exclusion of discitis or osteomyelitis versus arthritis
Commonly Confused Codes
- •M00.08: Staphylococcal arthritis of vertebrae (specific organism)
- •M46.20: Osteomyelitis of vertebra, unspecified (bone infection)
- •M46.30: Infection of intervertebral disc, unspecified (disc infection)
- •M06.88: Other specified rheumatoid arthritis of vertebrae (autoimmune)
- •M48.8: Other specified spondylopathies (mechanical)