M02.821
BillableOther reactive arthropathies, right elbow
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M02.821 an HCC code?
Yes. M02.821 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 M02.821
For M02.821to 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 M02.821 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M02.821 is the ICD-10-CM diagnosis code for other reactive arthropathies, right elbow. Joint inflammation of the right elbow caused by a reaction to infection elsewhere in the body. M02.821 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, M02.821 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, M02.821 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 'right' elbow is explicitly documented in the clinical notes. Because M02.821 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 M02.821 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify 'right' elbow is explicitly documented in the clinical notes
- •Reactive arthropathies typically resolve once the triggering infection is treated
Clinical Significance
Other reactive arthropathies affecting the right elbow represents joint inflammation secondary to bacterial infection elsewhere in the body, significantly impacting upper extremity function and elbow mobility. This reactive arthritis condition requires ongoing anti-inflammatory management and has important implications for patient functional capacity.
Documentation Requirements
- ✓Specific documentation of right elbow joint involvement
- ✓Evidence of reactive arthropathy following bacterial infection
- ✓Physical examination findings of elbow joint inflammation and limited range of motion
- ✓History of precipitating bacterial infection
- ✓Laboratory evidence of inflammatory markers
- ✓Assessment of upper extremity function and grip strength
- ✓Treatment response to anti-inflammatory medications
- ✓Differentiation from other elbow joint conditions