M02.822
BillableOther reactive arthropathies, left elbow
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M02.822 an HCC code?
Yes. M02.822 maps to Bone/Joint/Muscle 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 M02.822
For M02.822to 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 M02.822 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M02.822 is the ICD-10-CM diagnosis code for other reactive arthropathies, left elbow. Joint inflammation of the left elbow caused by a reaction to infection elsewhere in the body. M02.822 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, M02.822 maps to Bone/Joint/Muscle Infections/Necrosis (HCC 92) with a community, non-dual, aged base RAF weight of 0.209. Under the older V24 model, M02.822 mapped to the same category but with a base RAF weight of 0.482 — V28 recalibrated weights across the entire model. 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.
Confirm left-sided elbow involvement in documentation before assigning this code. Because M02.822 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 M02.822 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm left-sided elbow involvement in documentation before assigning this code
- •Check for bilateral involvement; code both sides separately if applicable
Clinical Significance
This diagnosis represents reactive arthritis affecting the left elbow, indicating joint inflammation secondary to an infection elsewhere in the body rather than direct joint infection. It's significant for risk adjustment as it maps to HCC 39 in V24 with a substantial RAF weight of 0.482, reflecting the chronic inflammatory nature and potential for complications requiring ongoing management.
Documentation Requirements
- ✓Clinical evidence of left elbow joint inflammation (swelling, pain, stiffness, warmth)
- ✓Documentation of reactive nature - inflammation secondary to remote infection
- ✓Specific anatomical location identified as left elbow joint
- ✓Evidence ruling out direct septic arthritis or other infectious arthropathies
- ✓Documentation of triggering infection or infectious process (if identified)
- ✓Physical examination findings consistent with arthritis
- ✓Exclusion of other arthropathy types (rheumatoid, osteoarthritis, crystal arthropathy)
- ✓Provider assessment linking joint symptoms to reactive process
Commonly Confused Codes
- •M00.022 — Direct staphylococcal arthritis of left elbow (infectious vs reactive)
- •M06.022 — Rheumatoid arthritis of left elbow (autoimmune vs reactive)
- •M19.022 — Primary osteoarthritis of left elbow (degenerative vs reactive)
- •M02.821 — Other reactive arthropathies, right elbow (laterality difference)
- •M25.522 — Pain in left elbow (symptom vs specific arthropathy diagnosis)