M02.169
BillablePostdysenteric arthropathy, unspecified knee
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M02.169 an HCC code?
Yes. M02.169 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 M02.169
For M02.169to 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 M02.169 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M02.169 is the ICD-10-CM diagnosis code for postdysenteric arthropathy, unspecified knee. Joint inflammation and pain in the knee (side not specified) that develops after a dysentery infection. M02.169 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, M02.169 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, M02.169 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 this code only when the specific knee (right or left) cannot be determined. Because M02.169 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 M02.169 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the specific knee (right or left) cannot be determined
- •Query provider documentation or imaging reports to establish laterality when possible
Clinical Significance
Postdysenteric arthropathy affecting the knee without specified laterality represents a chronic reactive arthritis that can significantly impact mobility and weight-bearing function. Despite unspecified laterality, this condition requires comprehensive management due to its potential for severe functional disability following dysentery infection.
Documentation Requirements
- ✓History of dysentery or infectious diarrheal illness documented
- ✓Knee joint involvement without laterality specification
- ✓Evidence of arthropathy symptoms affecting knee function
- ✓Post-infectious temporal relationship established
- ✓Chronic or persistent nature of joint inflammation
- ✓Mobility and functional capacity assessment
- ✓Physical findings consistent with knee arthritis
Commonly Confused Codes
- •M02.161 — Postdysenteric arthropathy, right knee (use when right side documented)
- •M02.162 — Postdysenteric arthropathy, left knee (use when left side documented)
- •M02.159 — Postdysenteric arthropathy, unspecified hip (different joint location)
- •M00.069 — Staphylococcal arthritis, unspecified knee (septic arthritis)
- •M25.569 — Pain in unspecified knee (symptom, not diagnosis)