M02.119
BillablePostdysenteric arthropathy, unspecified shoulder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M02.119 an HCC code?
Yes. M02.119 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).
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 M02.119
For M02.119to 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 M02.119 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M02.119 is the ICD-10-CM diagnosis code for postdysenteric arthropathy, unspecified shoulder. Joint inflammation and pain in the shoulder area following a dysentery infection, when the specific side (left or right) is not specified. M02.119 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, M02.119 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, M02.119 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.
Use only when documentation does not specify laterality; query provider if side can be determined. Because M02.119 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 M02.119 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Postdysenteric arthropathy represents a reactive arthritis that develops following dysentery infection, indicating an ongoing inflammatory joint condition that requires chronic management. This diagnosis captures a specific infectious arthropathy that can significantly impact patient mobility and quality of life, necessitating ongoing medical supervision and treatment.
Documentation Requirements
- ✓History of dysentery or severe infectious diarrheal illness
- ✓Documentation of joint inflammation or arthropathy in shoulder
- ✓Temporal relationship between infection and arthritis onset
- ✓Clinical signs of arthritis (swelling, pain, stiffness, decreased range of motion)
- ✓Exclusion of other causes of arthritis
- ✓Chronic or persistent nature of joint symptoms
- ✓Bilateral involvement or unspecified laterality clearly stated
Commonly Confused Codes
- •M02.111 — Postdysenteric arthropathy, right shoulder (use when laterality is specified)
- •M02.112 — Postdysenteric arthropathy, left shoulder (use when laterality is specified)
- •M02.30 — Reiter's disease, unspecified site (different type of reactive arthritis)
- •M06.9 — Rheumatoid arthritis, unspecified (not infection-related)
- •M19.91 — Unspecified osteoarthritis, shoulder region (degenerative, not reactive)