M02.162
BillablePostdysenteric arthropathy, left knee
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M02.162 an HCC code?
Yes. M02.162 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 M02.162
For M02.162to 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 M02.162 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M02.162 is the ICD-10-CM diagnosis code for postdysenteric arthropathy, left knee. Joint inflammation and pain in the left knee that develops after a dysentery infection (severe diarrheal illness). M02.162 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, M02.162 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, M02.162 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.
Verify left knee involvement is explicitly stated in clinical documentation. Because M02.162 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 M02.162 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify left knee involvement is explicitly stated in clinical documentation
- •Document the temporal relationship between dysentery infection and arthropathy onset
Clinical Significance
This diagnosis captures postdysenteric arthropathy specifically affecting the left knee, representing a chronic reactive arthritis that can severely impact mobility and functional independence. The condition requires ongoing management due to its post-infectious inflammatory nature and potential for progressive joint deterioration.
Documentation Requirements
- ✓Documented history of dysentery or severe diarrheal infection
- ✓Left knee joint involvement specifically identified
- ✓Clinical evidence of knee arthropathy and functional limitation
- ✓Established timeline between infection and knee arthritis onset
- ✓Chronic or ongoing nature of joint symptoms documented
- ✓Mobility and ambulation assessment
- ✓Physical examination findings supporting knee arthritis diagnosis
Commonly Confused Codes
- •M02.161 — Postdysenteric arthropathy, right knee (opposite side)
- •M02.169 — Postdysenteric arthropathy, unspecified knee (when laterality unknown)
- •M00.062 — Staphylococcal arthritis, left knee (septic arthritis, not reactive)
- •M17.12 — Unilateral primary osteoarthritis, left knee (degenerative condition)
- •M25.562 — Pain in left knee (symptom code, not diagnostic)